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Bae NY, Rhee TM, Park CS, Choi YJ, Lee HJ, Choi HM, Park JB, Yoon YE, Kim YJ, Cho GY, Hwang IC, Kim HK. Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy. J Korean Med Sci 2024; 39:e80. [PMID: 38442721 PMCID: PMC10911940 DOI: 10.3346/jkms.2024.39.e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM. METHODS Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates. RESULTS Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased. CONCLUSION This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.
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Affiliation(s)
- Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - You-Jung Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Mi Choi
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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Choi HM, Hwang IC, Choi HJ, Yoon YE, Lee HJ, Park JB, Lee SP, Kim HK, Kim YJ, Cho GY. Irreversible myocardial injury attenuates the benefits of sacubitril/valsartan in heart failure patients. Int J Cardiol 2024; 397:131611. [PMID: 38030041 DOI: 10.1016/j.ijcard.2023.131611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Despite the established benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) across various etiologies, there are controversies regarding the effects of ARNI in patients with irreversible myocardial injury. The aim of this study is to investigate the impact of irreversible myocardial injury on the benefits of ARNI treatment in patients with HFrEF, consisted of both ischemic and non-ischemic etiologies. METHODS AND RESULTS We conducted a retrospective single-center study including 409 consecutive patients with HFrEF treated with ARNI between March 2017 and May 2020. Irreversible myocardial injury was defined as nonviable myocardium without contractile reserve, which suggests a limited potential for recovery of left ventricular function and geometry. At baseline, irreversible myocardial injury was observed in 129 (31.5%) patients. Composite outcome was cardiovascular death or hospitalization for heart failure, which occurred in 56 (43.4%) and 61 (21.8%) patients with and without irreversible myocardial injury, respectively. On multivariable analysis, irreversible injury presence, but not ischemic etiology, was an independent predictor of composite outcome (hazard ratio 2.16, 95% confidence interval 1.33-3.49). Mediation analysis revealed that the increased risk of the composite outcome due to irreversible myocardial injury was mediated by attenuated LV reverse remodeling (Z value = 2.02, P = 0.043). CONCLUSIONS The presence of irreversible myocardial injury was significantly associated with the response to ARNI treatment in patients with HFrEF, regardless of etiology.
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Affiliation(s)
- Hong-Mi Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hye Jung Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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Lim J, Kwak S, Choi YJ, Rhee TM, Park CS, Kim B, Han KD, Lee H, Park JB, Kim YJ, Lee HJ, Kim HK. Differing Efficacy of Dapagliflozin Versus Empagliflozin on the Risk of Incident Atrial Fibrillation in Patients With Type 2 Diabetes: A Real-World Observation Using a Nationwide, Population-Based Cohort. J Am Heart Assoc 2024; 13:e030552. [PMID: 38258668 DOI: 10.1161/jaha.123.030552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Meta-analyses of large clinical trials investigating SGLT2 (sodium-glucose cotransporter-2) inhibitors have suggested their protective effects against atrial fibrillation in patients with type 2 diabetes. However, the results were predominantly driven from trials involving dapagliflozin. METHODS AND RESULTS We used a nationwide, population-based cohort of patients with type 2 diabetes who initiated either dapagliflozin or empagliflozin between May 2016 and December 2018. An active-comparator, new-user design was used, and the 2 groups of patients were matched using propensity scores. The primary outcome was incident nonvalvular atrial fibrillation, which was analyzed using both the main intention-to-treat and sensitivity analysis that censored patients who skipped their medications for ≥30 days. Men ≥55 years of age and women ≥60 years of age with ≥1 traditional risk factor or those with established cardiovascular disease were categorized as high cardiovascular risk group. Patients not included in the high-risk group were categorized as low risk. After 1:1 propensity-score matching, a total of 137 928 patients (mean age, 55 years; 58% men) were included and followed up for 2.2±0.6 years. The risk of incident atrial fibrillation was significantly lower in the dapagliflozin group in both the main (hazard ratio [HR], 0.885 [95% CI, 0.789-0.992]) and sensitivity analyses (HR, 0.835 [95% CI, 0.719-0.970]). Notably, this was consistent in both the low and high cardiovascular risk groups. There was no effect modification by age, sex, body mass index, duration of diabetes, or renal function. CONCLUSIONS This real-world, population-based study demonstrates that patients with type 2 diabetes using dapagliflozin may have a lower risk of developing nonvalvular atrial fibrillation than those using empagliflozin.
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Affiliation(s)
- Jaehyun Lim
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Soongu Kwak
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - You-Jung Choi
- Division of Cardiology, Department of Internal Medicine Korea University College of Medicine Seoul Republic of Korea
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine Seoul National University Hospital Healthcare System Gangnam Center Seoul Republic of Korea
| | - Chan Soon Park
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine Seoul National University Hospital Healthcare System Gangnam Center Seoul Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology Severance Hospital, Yonsei University College of Medicine Seoul Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
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Kwak S, Lee HJ, Lee H, Park JB, Kim YJ, Han K, Kim HK. Age-dependent association of metabolic dyslipidemia with clinical expression of hypertrophic cardiomyopathy. Int J Cardiol 2024; 396:131574. [PMID: 37935337 DOI: 10.1016/j.ijcard.2023.131574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Previous studies have shown that the clinical expression of hypertrophic cardiomyopathy (HCM) can be determined by obesity and metabolic syndrome. The present study aimed to investigate the association between triglyceride and high-density lipoprotein cholesterol (HDLC) level, the two dyslipidemia-related components of metabolic syndrome, and the incidence of HCM. We also explored an age-dependent association between them. METHODS Individuals without previous HCM diagnosis who underwent a designated national health examination in 2009 were recruited. Individuals who used lipid-lowering medications within 1-year of the baseline were excluded. The outcome of interest was a newly diagnosed HCM. RESULTS Our cohort consisted of 8,652,709 individuals (mean 46 years, 55.6% men). During the median 9.3 years of follow-up, 5932 (0.07%) individuals were newly diagnosed with HCM. There was a gradual increase in the incidence of HCM towards higher triglyceride and lower HDL-C levels (log-rank p < 0.001). When stratified by age, the incidence of HCM was highest in individuals aged ≥65 years, followed by those aged 40-64 and 20-39 years (0.22% vs. 0.07% vs. 0.03%, log-rank p < 0.001). In individuals aged 20-39 years, a higher triglyceride level was associated with a higher incidence of HCM (i.e., ≥200 vs. <100 mg/dL: adjusted hazard ratio 2.28, 95% confidence interval 1.89-2.75), whereas there was no significant association in older groups (p-for-interaction<0.001). Similarly, a lower HDL-C level was associated with a higher incidence of HCM, particularly in individuals aged 20-39 years (p-for-interaction = 0.001). CONCLUSIONS High triglyceride and low HDL-C levels are associated with a higher incidence of HCM, particularly in young individuals.
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Affiliation(s)
- Soongu Kwak
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesun Lee
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
| | - Hyung-Kwan Kim
- Department of Internal medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Baek JY, Seo SH, Cho S, Park JB, Keam B, Yoo SH, Shin A. Emergency department visits of newly diagnosed cardiovascular disease patients in Korea during the COVID-19 pandemic. Sci Rep 2024; 14:397. [PMID: 38172246 PMCID: PMC10764744 DOI: 10.1038/s41598-023-50709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to examine the impact of the COVID-19 pandemic on the emergency department (ED) visits of cardiovascular disease (CVD) patients. The customized data of the National Health Insurance Service (NHIS) from 2017 to 2020 were analyzed. CVD patients were defined by the code 'V192' based on the NHIS coverage benefit expansion policy. The number of ED visits of CVD patients, as well as executed procedures in 2020 (during the pandemic), were compared to the corresponding average numbers in 2018 and 2019 (prepandemic). Stratification by age group, residential area and hospital location was performed. The number of ED visits of newly diagnosed CVD patients decreased by 2.1% nationwide in 2020 (2018-2019: 97,041; 2020: 95,038) and decreased the most (by 14.1%) in March (2018-2019: 8539; 2020: 7334). However, the number of executed procedures increased by 1.1% nationwide in 2020 (2018-2019: 74,696; 2020: 75,520), while it decreased by 11.9% in April (2018-2019: 6603; 2020: 5819). The most notable decreases in the number of newly diagnosed CVD patients (31.7%) and procedures (29.2%) in March 2020 were observed in the Daegu·Gyeongbuk area. CVD patients living in the epicenter of the COVID-19 pandemic may experience difficulty accessing healthcare facilities and receiving proper treatment.
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Affiliation(s)
- Ji Yoon Baek
- Cancer Research Institute, Seoul National University, Seoul, South Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | - Seung Hee Seo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | - Sooyoung Cho
- Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Aesun Shin
- Cancer Research Institute, Seoul National University, Seoul, South Korea.
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea.
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea.
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Republic of Korea.
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Lee HJ, Kim HK, Lee SC, Kim J, Park JB, Lee SP, Kim YJ. Performance of 2020 AHA/ACC HCM Guidelines and Incremental Value of Myocardial Strain for Predicting SCD. JACC Asia 2024; 4:10-22. [PMID: 38222259 PMCID: PMC10782402 DOI: 10.1016/j.jacasi.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 01/16/2024]
Abstract
Background The 2020 American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) need further international validation. Objectives Performance of the guidelines and the incremental value of myocardial strain for predicting SCD in HCM were investigated. Methods In 1,416 HCM patients, SCD risk was stratified according to the 2020 AHA/ACC and 2014 European Society of Cardiology (ESC) guidelines. Left ventricular (LV) global longitudinal strain (GLS) and left atrial reservoir strain (LARS) were measured. The main outcome consisted of SCD events. Results Overall, 29.1% had major risk factors (RFs), and 14.7% had nonmajor RFs in the absence of major RFs; estimated 5-year SCD event rates were 6.8% and 2.3%, respectively. SCD risk was significantly increased in the former group but not in the latter. When stratified by the number of RFs, 5-year SCD event rates were 1.9%, 3.0%, 4.9%, and 18.4% for patients with 0, 1, 2, and 3 or more RFs, respectively. SCD risk was elevated in patients with multiple RFs but not in those with a single RF. Performance of the AHA/ACC and ESC guidelines did not differ significantly over 10 years (5-year time-dependent area under the curve: 0.677 vs 0.724; P = 0.235). Decreased LV GLS and LARS were independently associated with SCD events with optimal cutoffs of LV GLS <13% and LARS <21%. Adding LV GLS and LARS to the guidelines had incremental predictive value. Conclusions The 2020 AHA/ACC guidelines were predictive of SCD events with modest power in a large Asian HCM cohort. Implantable cardioverter-defibrillators are reasonable in patients with multiple RFs, and consideration of myocardial strain can improve SCD prediction.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Torkamani A, Chen SF, Lee SE, Sadaei H, Park JB, Khattab A, Henegar C, Wineinger N, Muse E. Meta-Prediction of Coronary Artery Disease Risk. Res Sq 2023:rs.3.rs-3694374. [PMID: 38196609 PMCID: PMC10775391 DOI: 10.21203/rs.3.rs-3694374/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide. Recent advances in large-scale genome-wide association studies have highlighted the potential of genetic risk, captured as polygenic risk scores (PRS), in clinical prevention. However, the current clinical utility of PRS models is limited to identifying high-risk populations based on the top percentiles of genetic susceptibility. While some studies have attempted integrative prediction using genetic and non-genetic factors, many of these studies have been cross-sectional and focused solely on risk stratification. Our primary objective in this study was to integrate unmodifiable (age / genetics) and modifiable (clinical / biometric) risk factors into a prospective prediction framework which also produces actionable and personalized risk estimates for the purpose of CAD prevention in a heterogenous adult population. Thus, we present an integrative, omnigenic, meta-prediction framework that effectively captures CAD risk subgroups, primarily distinguished by degree and nature of genetic risk, with distinct risk reduction profiles predicted from standard clinical interventions. Initial model development considered ~ 2,000 predictive features, including demographic data, lifestyle factors, physical measurements, laboratory tests, medication usage, diagnoses, and genetics. To power our meta-prediction approach, we stratified the UK Biobank into two primary cohorts: 1) a prevalent CAD cohort used to train baseline and prospective predictive models for contributing risk factors and diagnoses, and 2) an incident CAD cohort used to train the final CAD incident risk prediction model. The resultant 10-year incident CAD risk model is composed of 35 derived meta-features from models trained on the prevalent risk cohort, most of which are predicted baseline diagnoses with multiple embedded PRSs. This model achieved an AUC of 0.81 and macro-averaged F1-score of 0.65, outperforming standard clinical scores and prior integrative models. We further demonstrate that individualized risk reduction profiles can be derived from this model, with genetic risk mediating the degree of risk reduction achieved by standard clinical interventions.
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Affiliation(s)
- Ali Torkamani
- Scripps Research & Scripps Research Translational Institute
| | - Shang-Fu Chen
- Scripps Research & Scripps Research Translational Institute
| | - Sang Eun Lee
- Asan Medical Center, University of Ulsan College of Medicine
| | - Hossein Sadaei
- Scripps Research & Scripps Research Translational Institute
| | | | - Ahmed Khattab
- Scripps Research & Scripps Research Translational Institute
| | | | | | - Evan Muse
- Scripps Translational Science Institute, The Scripps Research Institute, Scripps Health
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Kim KJ, Park JB, Lee SP, Kim HK, Kim YJ. Thalidomide and a Dipeptidyl Peptidase 4 Inhibitor in a Rat Model of Experimental Autoimmune Myocarditis. Korean Circ J 2023; 53:795-810. [PMID: 37880871 PMCID: PMC10751183 DOI: 10.4070/kcj.2023.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Myocarditis is a potentially fatal disease, but curative treatments have not yet been established. Myocardial inflammation is an important pathogenesis of this disease, and immunosuppressants such as methylprednisolone and immunoglobulin have been used for treatment; however, the effectiveness needs to be improved. Thalidomide and dipeptidyl peptidase (DPP) 4 inhibitors were recently investigated regarding their immunomodulatory properties. This study aimed to test whether thalidomide or a DPP4 inhibitor (evogliptin) can improve the effectiveness of myocarditis treatment using a rat model of experimental autoimmune myocarditis (EAM). METHODS Rats with or without myocarditis were administered thalidomide at 100 mg/kg/day and DPP4 inhibitor at 10 mg/kg/day orally. Measurement of echocardiography, serum inflammatory cytokines, myocardial histopathological examination, and immunohistochemical staining for leukocytes, macrophages, CD4+ T cells, and cytoskeleton were performed after 3 weeks, and the fibrosis area was measured after 3 and 6 weeks. RESULTS Thalidomide and DPP4 inhibitor did not reduce the severity of myocarditis compared with the EAM without treatment rats by comparing the echocardiographic data, myocardial CD4+, macrophages, neutrophil infiltrations, and the heart weight/body weight ratio in 3 weeks. The levels of inflammatory cytokines were not lower in the thalidomide and DPP4 inhibitor-treated group than in the untreated group in 3 weeks. In 6 weeks, thalidomide and DPP4 inhibitors did not reduce the fibrosis area compared to untreated groups. CONCLUSIONS Although thalidomide and the DPP4 inhibitor had an immunomodulatory effect and are used against inflammatory diseases, they did not ameliorate myocardial inflammation and fibrosis in this rat model of EAM.
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Affiliation(s)
- Kyung-Jin Kim
- Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Park CS, Kim B, Rhee TM, Lee HJ, Lee HS, Park JB, Kim YJ, Han KD, Kim HK. Association between renin-angiotensin-aldosterone system blockade and clinical outcomes in patients with hypertension: real-world observation from a nationwide hypertension cohort. Clin Res Cardiol 2023; 112:1577-1586. [PMID: 36867200 DOI: 10.1007/s00392-023-02179-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE We investigated the association between the use of ACEi, ARB, or non-renin-angiotensin-aldosterone system inhibitors (non-RASi) and incident cardiovascular events in an unselected nationwide hypertension cohort. METHODS The information regarding 2,025,849 patients who underwent general health checkup between 2010 and 2011 and were on antihypertensive medication was collected. Patients were allocated into ACEi, ARB, and non-RASi groups and followed until 2019. The outcomes of interest were myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause deaths. RESULTS Patients on ACEi and ARB showed unfavorable baseline characteristics compared to those on non-RASi. After adjusting for covariates, the ACEi group showed lower risks of MI, AF, and all-cause deaths (HR (95% CI): 0.94 (0.89-0.99), 0.96 (0.92-1.00), and 0.93 (0.90-0.96), respectively), but similar risks of IS and HF (0.97 (0.92-1.01) and 1.03 (1.00-1.06), respectively), compared to the non-RASi group. Likewise, the ARB group showed decreased risks of MI, IS, AF, HF, and all-cause deaths (HR (95% CI): 0.93 (0.91-0.95), 0.88 (0.86-0.90), 0.86 (0.85-0.88), 0.94 (0.93-0.96), and 0.84 (0.83-0.85)), compared to the non-RASi group. Sensitivity analysis of patients taking a single antihypertensive medication showed similar results. In the propensity score matching (PSM) cohort, the ARB group showed similar risks of MI and decreased risks of IS, AF, HF, and all-cause deaths compared to the ACEi group. CONCLUSIONS ACEi and ARB users were associated with decreased risks of MI, IS, AF, HF, and all-cause deaths, compared to non-RASi users.
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Affiliation(s)
- Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Sun Lee
- Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Lee HJ, Kim HK, Kim BS, Han KD, Kwak S, Park CS, Rhee TM, Park JB, Lee H, Kim YJ. Sacubitril/valsartan and the risk of incident dementia in heart failure: a nationwide propensity-matched cohort study. Clin Res Cardiol 2023:10.1007/s00392-023-02322-0. [PMID: 37906294 DOI: 10.1007/s00392-023-02322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Sacubitril acts to inhibit neprilysin and as neprilysin is involved in amyloid-beta degradation in the central nervous system, and there is concern that sacubitril/valsartan may increase the risk of dementia. We aimed to compare the risk of incident dementia associated with sacubitril/valsartan and angiotensin II receptor blockers (ARBs). METHODS Patients with heart failure with reduced ejection fraction treated with either sacubitril/valsartan or ARB, identified from the Korean National Health Insurance Service database, were matched in a 1:2 ratio using propensity scores (6789 on sacubitril/valsartan and 13,578 on ARBs) and followed up for incident dementia. RESULTS During a mean follow-up of 2.5 years, 526 (2.6%) patients were newly diagnosed with dementia: Alzheimer dementia in 282, vascular dementia in 8, and other dementia in 236. There was no significant difference in the risk of overall dementia (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.70-1.01), Alzheimer dementia (HR 0.85, 95% CI 0.67-1.10), vascular dementia (HR 0.98, 95% CI 0.23-4.11), and all other dementias (HR 0.81, 95% CI 0.62-1.07) between sacubitril/valsartan users and ARB users. These results were consistent regardless of initial sacubitril/valsartan dose and subgroups including old age, previous mild cognitive impairment, previous stroke, and concomitant antiplatelet or anticoagulation. Sensitivity analysis with a 1-year lag period for dementia assessment confirmed the main analysis. Meanwhile, risk of incident stroke was lower in sacubitril/valsartan users compared to ARBs users. CONCLUSIONS In a nationwide propensity-matched cohort of patients with heart failure, sacubitril/valsartan was not associated with an increased risk of incident dementia compared to ARBs. Sacubitril/valsartan and the risk of incident dementia in heart failure. ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor.
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Affiliation(s)
- Hyun-Jung Lee
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seo-Daemun-gu, Seoul, Korea
| | - Hyung-Kwan Kim
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea.
| | - Bong-Seong Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul, Korea
| | - Soongu Kwak
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea
| | - Chan Soon Park
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152, Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Jun-Bean Park
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152, Teheran-ro, Gangnam-gu, Seoul, Korea
| | - Yong-Jin Kim
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea
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11
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Park JB, Jang BS, Chang JH, Kim JH, Hong KY, Jin US, Chang H, Myung Y, Jeong JH, Heo CY, Kim IA, Shin KH. Impact of the New ESTRO-ACROP Target Volume Delineation Guideline on Breast-Related Complications after Implant-Based Reconstruction and Postmastectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e198. [PMID: 37784842 DOI: 10.1016/j.ijrobp.2023.06.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) recently updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed whether this change has impact on breast-related complications. MATERIALS/METHODS We retrospectively reviewed patients who underwent PMRT after mastectomy with tissue expander or permanent implant insertion from 2016 to 2021. In total, 412 patients were included; 277 received RT by the new ESTRO-ACROP target delineation (ESTRO-T), and 135 received RT by conventional target delineation (CONV-T). The primary endpoint was comparison between the target groups of major breast-related complication, including infection, capsular contracture, deformity and necrosis requiring re-operation or re-hospitalization during follow-up after RT or delayed implant replacement. Complications were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0., and capsular contracture was graded by the Baker Classification. RESULTS The median follow-up was 29.5 months (range, 0.3-76.8). The 1-, 2-, and 3-year incidence rates of major breast-related complication were 5.7%, 10.0%, and 11.6% in the ESTRO-T group, and 8.2%, 13.8%, and 14.7% in the CONV-T groups; it did not show a difference between the groups (P = 0.55). In multivariate analyses, target delineation is not significantly associated with the major complications (hazard ratio [HR] = 0.93; P = 0.83, Table 1). There was no significant difference between the ESTRO-T and CONV-T groups in the incidence of any breast-related complications (3-year cumulative incidence, 37.3% vs. 29.4%, respectively; P = 0.28). Symptomatic RT-induced pneumonitis rates were 2.7% in the ESTRO-T group (7 patients) and 2.2% in the CONV-T group (3 patients). Only one local recurrence event occurred in the ESTRO-T group, which was within the ESTRO-target volume. CONCLUSION Target volume delineation according to the new ESTRO-ACROP guideline did not reduce the risk of major or any breast-related complications. As the dosimetric benefits of heart and lung have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.
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Affiliation(s)
- J B Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - B S Jang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J H Chang
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J H Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - K Y Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - U S Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - H Chang
- 2nd Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - Y Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - J H Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - C Y Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - I A Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - K H Shin
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
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Choi YJ, Lee HJ, Park JS, Park CS, Rhee TM, Choi JY, Choi HM, Park JB, Yoon YE, Lee SP, Na JO, Cho GY, Kim YJ, Hwang IC, Kim HK. Left ventricular global longitudinal strain as a prognosticator in hypertrophic cardiomyopathy with a low-normal left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:1374-1383. [PMID: 37467475 DOI: 10.1093/ehjci/jead177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/15/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023] Open
Abstract
AIMS The aim of this study was to investigate the prognostic utility of left ventricular (LV) global longitudinal strain (LV-GLS) in patients with hypertrophic cardiomyopathy (HCM) and an LV ejection fraction (LVEF) of 50-60%. METHODS AND RESULTS This retrospective cohort study included 349 patients with HCM and an LVEF of 50-60%. The primary outcome was a composite of cardiovascular death, including sudden cardiac death (SCD) and SCD-equivalent events. The secondary outcomes were SCD/SCD-equivalent events, cardiovascular death (including SCD), and all-cause death. The final analysis included 349 patients (mean age 59.2 ± 14.2 years, men 75.6%). During a median follow-up of 4.1 years, the primary outcome occurred in 26 (7.4%), while the secondary outcomes of SCD/SCD-equivalent events, cardiovascular death, and all-cause death occurred in 15 (4.2%), 20 (5.7%), and 34 (9.7%), respectively. After adjusting for age, atrial fibrillation, ischaemic stroke, LVEF, and left atrial volume index, absolute LV-GLS (%) was independently associated with the primary outcome [adjusted hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.788-0.988, P = 0.029]. According to receiver operating characteristic analysis, 10.5% is an optimal cut-off value for absolute LV-GLS in predicting the primary outcome. Patients with an absolute LV-GLS ≤ 10.5% had a higher risk of the primary outcome than those with an absolute LV-GLS > 10.5% (adjusted HR 2.54, 95% CI 1.117-5.787, P = 0.026). Absolute LV-GLS ≤ 10.5% was an independent predictor for each secondary outcome (P < 0.05). CONCLUSIONS LV-GLS was an independent predictor of a composite of cardiovascular death, including SCD/SCD-equivalent events, in patients with HCM and an LVEF of 50-60%. Therefore, LV-GLS can help in risk stratification in these patients.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Suck Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Chan Soon Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jah Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hong-Mi Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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13
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Park CS, Rhee TM, Lee HJ, Yoon YE, Park JB, Lee SP, Kim YJ, Cho GY, Hwang IC, Kim HK. Prognostic and Safety Implications of Renin-Angiotensin-Aldosterone System Inhibitors in Hypertrophic Cardiomyopathy: A Real-World Observation Over 2,000 Patients. Korean Circ J 2023; 53:606-618. [PMID: 37653696 PMCID: PMC10475688 DOI: 10.4070/kcj.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The prognostic or safety implication of renin-angiotensin-aldosterone system inhibitors (RASi) in hypertrophic cardiomyopathy (HCM) are not well established, mainly due to concerns regarding left ventricular outflow tract (LVOT) obstruction aggravation. We investigated the implications of RASi in a sizable number of HCM patients. METHODS We enrolled 2,104 consecutive patients diagnosed with HCM in 2 tertiary university hospitals and followed up for five years. RASi use was defined as the administration of RASi after diagnostic confirmation of HCM. The primary and secondary outcomes were all-cause mortality and hospitalization for heart failure (HHF). RESULTS RASi were prescribed to 762 patients (36.2%). During a median follow-up of 48.1 months, 112 patients (5.3%) died, and 94 patients (4.5%) experienced HHF. Patients using RASi had less favorable baseline characteristics than those not using RASi, such as older age, more frequent history of comorbidities, and lower ejection fraction. Nonetheless, there was no difference in clinical outcomes between patients with and without RASi use (log-rank p=0.368 for all-cause mortality and log-rank p=0.443 for HHF). In multivariable analysis, patients taking RASi showed a comparable risk of all-cause mortality (hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.43-1.14, p=0.150) and HHF (HR, 1.03, 95% CI, 0.63-1.70, p=0.900). In the subgroup analysis, there was no significant interaction of RASi use between subgroups stratified by LVOT obstruction, left ventricular (LV) ejection fraction, or maximal LV wall thickness. CONCLUSIONS RASi use was not associated with worse clinical outcomes. It might be safely administered in patients with HCM if clinically indicated.
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Affiliation(s)
- Chan Soon Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Tae-Min Rhee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun-Bean Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Kwak S, Lee SA, Lim J, Yang S, Hwang D, Lee HJ, Choi HM, Hwang IC, Lee S, Yoon YE, Park JB, Kim HK, Kim YJ, Song JM, Cho GY, Kang DH, Kim DH, Lee SP. Data-driven mortality risk prediction of severe degenerative mitral regurgitation patients undergoing mitral valve surgery. Eur Heart J Cardiovasc Imaging 2023; 24:1156-1165. [PMID: 37115641 DOI: 10.1093/ehjci/jead077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
AIMS The outcomes of mitral valve replacement/repair (MVR) in severe degenerative mitral regurgitation (MR) patients depend on various risk factors. We aimed to develop a risk prediction model for post-MVR mortality in severe degenerative MR patients using machine learning. METHODS AND RESULTS Consecutive severe degenerative MR patients undergoing MVR were analysed (n = 1521; 70% training/30% test sets). A random survival forest (RSF) model was constructed, with 3-year post-MVR all-cause mortality as the outcome. Partial dependency plots were used to define the thresholds of each risk factor. A simple scoring system (MVR-score) was developed to stratify post-MVR mortality risk. At 3 years following MVR, 90 patients (5.9%) died in the entire cohort (59 and 31 deaths in the training and test sets). The most important predictors of mortality in order of importance were age, haemoglobin, valve replacement, glomerular filtration rate, left atrial dimension, and left ventricular (LV) end-systolic diameter. The final RSF model with these six variables demonstrated high predictive performance in the test set (3-year C-index 0.880, 95% confidence interval 0.834-0.925), with mortality risk increased strongly with left atrial dimension >55 mm, and LV end-systolic diameter >45 mm. MVR-score demonstrated effective risk stratification and had significantly higher predictability compared to the modified Mitral Regurgitation International Database score (3-year C-index 0.803 vs. 0.750, P = 0.034). CONCLUSION A data-driven machine learning model provided accurate post-MVR mortality prediction in severe degenerative MR patients. The outcome following MVR in severe degenerative MR patients is governed by both clinical and echocardiographic factors.
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Affiliation(s)
- Soongu Kwak
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jaehyun Lim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Seokhun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Doyeon Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Hong-Mi Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Sahmin Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Yeonyee E Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jong-Min Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Center for Precision Medicine, Seoul National University Hospital, 71, Daehak-ro, Jongno-gu, Seoul 03082, South Korea
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15
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Lim J, Choi YJ, Kim BS, Rhee TM, Lee HJ, Han KD, Park JB, Na JO, Kim YJ, Lee H, Kim HK. Comparative cardiovascular outcomes in type 2 diabetes patients taking dapagliflozin versus empagliflozin: a nationwide population-based cohort study. Cardiovasc Diabetol 2023; 22:188. [PMID: 37496050 PMCID: PMC10373410 DOI: 10.1186/s12933-023-01911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/01/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Sodium-glucose co-transporter-2 inhibitors displayed cardiovascular benefits in type 2 diabetes mellitus in previous studies; however, there were some heterogeneities regarding respective cardiovascular outcomes within the class. Furthermore, their efficacies in Asians, females, and those with low cardiovascular risks were under-represented. Thus, we compared the cardiovascular outcomes between new users of dapagliflozin and empagliflozin in a broad range of patients with type 2 diabetes mellitus using a nationwide population-based real-world cohort from Korea. METHODS Korean National Health Insurance registry data between May 2016 and December 2018 were extracted, and an active-comparator new-user design was applied. The primary outcome was a composite of heart failure (HF)-related events (i.e., hospitalization for HF and HF-related death), myocardial infarction, ischemic stroke, and cardiovascular death. The secondary outcomes were individual components of the primary outcome. RESULTS A total of 366,031 new users of dapagliflozin or empagliflozin were identified. After 1:1 nearest-neighbor propensity score matching, 72,752 individuals (mean age approximately 56 years, 42% women) from each group were included in the final analysis, with a follow-up of 150,000 ~ person-years. Approximately 40% of the patients included in the study had type 2 diabetes mellitus as their sole cardiovascular risk factor, with no other risk factors. The risk of the primary outcome was not different significantly between dapagliflozin and empagliflozin users (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.855-1.006). The risks of secondary outcomes were also similar, with the exception of the risks of HF-related events (HR 0.84, 95% CI 0.714-0.989) and cardiovascular death (HR 0.76, 95% CI 0.618-0.921), which were significantly lower in the dapagliflozin users. CONCLUSIONS This large-scale nationwide population-based real-world cohort study revealed no significant difference in composite cardiovascular outcomes between new users of dapagliflozin and empagliflozin. However, dapagliflozin might be associated with lower risks of hospitalization or death due to HF and cardiovascular death than empagliflozin in Asian patients with type 2 diabetes mellitus.
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Affiliation(s)
- Jaehyun Lim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bong Sung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Diagnostic Test Unit Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital,, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Diagnostic Test Unit Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital,, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152, Teheran-ro, Gangnam-gu,, Seoul, Republic of Korea.
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Diagnostic Test Unit Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital,, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea.
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16
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Kwak S, Lee HJ, Kim S, Park JB, Lee SP, Kim HK, Kim YJ. Machine learning reveals sex-specific associations between cardiovascular risk factors and incident atherosclerotic cardiovascular disease. Sci Rep 2023; 13:9364. [PMID: 37291421 PMCID: PMC10250402 DOI: 10.1038/s41598-023-36450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023] Open
Abstract
We aimed to investigate sex-specific associations between cardiovascular risk factors and atherosclerotic cardiovascular disease (ASCVD) risk using machine learning. We studied 258,279 individuals (132,505 [51.3%] men and 125,774 [48.7%] women) without documented ASCVD who underwent national health screening. A random forest model was developed using 16 variables to predict the 10-year ASCVD in each sex. The association between cardiovascular risk factors and 10-year ASCVD probabilities was examined using partial dependency plots. During the 10-year follow-up, 12,319 (4.8%) individuals developed ASCVD, with a higher incidence in men than in women (5.3% vs. 4.2%, P < 0.001). The performance of the random forest model was similar to that of the pooled cohort equations (area under the receiver operating characteristic curve, men: 0.733 vs. 0.727; women: 0.769 vs. 0.762). Age and body mass index were the two most important predictors in the random forest model for both sexes. In partial dependency plots, advanced age and increased waist circumference were more strongly associated with higher probabilities of ASCVD in women. In contrast, ASCVD probabilities increased more steeply with higher total cholesterol and low-density lipoprotein (LDL) cholesterol levels in men. These sex-specific associations were verified in the conventional Cox analyses. In conclusion, there were significant sex differences in the association between cardiovascular risk factors and ASCVD events. While higher total cholesterol or LDL cholesterol levels were more strongly associated with the risk of ASCVD in men, older age and increased waist circumference were more strongly associated with the risk of ASCVD in women.
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Affiliation(s)
- Soongu Kwak
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Seungyeon Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
- College of Pharmacy, Dankook University, Dandae-ro 119, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea.
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
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17
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Rhee TM, Kim HK, Kim BS, Han KD, Lee HJ, Hwang IC, Lee H, Park JB, Yoon YE, Kim YJ, Cho GY. Impact of coronary artery revascularization on long-term outcome in hypertrophic cardiomyopathy patients: a nationwide population-based cohort study. Sci Rep 2023; 13:6412. [PMID: 37076510 PMCID: PMC10115788 DOI: 10.1038/s41598-023-33344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
Limited data are available on the long-term outcomes in patients with hypertrophic cardiomyopathy (HCM) patients with significant coronary artery disease (CAD) requiring revascularization. We investigated the risk of cardiovascular outcomes in HCM patients who underwent coronary revascularization compared to the control group without HCM. HCM patients aged ≥ 20 years were enrolled from the Korean National Health Insurance Database. Information on the diagnosis and previous medical history was obtained from the claims data. Cardiovascular outcomes were identified during 8-year after coronary revascularization in HCM patients (HCM group) and matched controls without HCM (non-HCM control group). A total of 431 patients in the HCM group and 1968 in the non-HCM control group were analyzed. The risk of all-cause death, cardiovascular death, sudden cardiac death (SCD), ischemic stroke, and hospitalization due to heart failure was significantly higher in the HCM group than in the non-HCM group, with prominent risk increase of cardiovascular death (adjusted hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.63-3.15, P < 0.001) and ischemic stroke (adjusted HR 2.38, 95% CI 1.55-3.64, P < 0.001). Beyond 1-year after revascularization, the HCM group still had a significantly higher risk of cardiovascular death, SCD, and ventricular fibrillation/tachycardia compared to the non-HCM group. Mortality and major cardiovascular outcomes occurred more frequently in HCM patients with significant CAD requiring revascularization, compared to the matched non-HCM control group. Active and regular surveillance for concomitant risk factors and relevant intervention are warranted in HCM patients at increased risk for CAD.
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Affiliation(s)
- Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
| | - Bong-Seong Kim
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
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18
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Abstract
The diagnostic yield of endomyocardial biopsy in cardiac sarcoidosis (CS) is quite low because of the patchy involvement, and for the diagnosis of CS, existing guidelines required histological confirmation. Therefore, especially for isolated CS, diagnosis consistent with the guidelines cannot be made in a large number of patients. With recent developments in imaging modalities such as cardiac magnetic resonance and 18-fluorodeoxyglucose positron emission tomography, diagnosing CS has become easier and diagnostic criteria for CS not compulsorily requiring histological confirmation have been suggested. Despite significant advances in diagnostic tools, large-scale studies that can guide treatment plans are still lacking, and treatment has relied on the experience accumulated over the past years and the consensus of experts. However, opinions vary, depending on the situation, which is quite puzzling for the physician treating CS. Moreover, with the advent of new immunosuppressant agents, these new drugs have been applied under the assumption that the effect of immunosuppression is not much different from that of other well-known autoimmune diseases that require immunosuppression. However, we should wait to see the beneficial effects of these new immunosuppressants before we attempt to apply these agents in our clinical practice. This review summarises the widely used diagnostic criteria, current diagnostic modalities and recommended treatments for sarcoidosis. We have added our opinions on selecting or modifying diagnostic and treatment plans from the diverse current recommendations.
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Affiliation(s)
- Dae-Won Sohn
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea .,Seoul One-Heart CV Clinic, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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19
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Lee HJ, Park CS, Lee S, Park JB, Kim HK, Park SJ, Kim YJ, Lee SP. Systemic proinflammatory-profibrotic response in aortic stenosis patients with diabetes and its relationship with myocardial remodeling and clinical outcome. Cardiovasc Diabetol 2023; 22:30. [PMID: 36765354 PMCID: PMC9921197 DOI: 10.1186/s12933-023-01763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Previous studies have mainly focused more on how diabetes affects the valve than the myocardium in aortic stenosis (AS). In the pressure-overloaded heart, myocardial fibrosis is an important driver of the progression from compensated hypertrophy to heart failure. Using comprehensive noninvasive imaging and plasma proteomics, we investigated whether and how diabetes aggravates the remodeling of the myocardium and its relation with prognosis in AS patients. METHODS Severe AS patients were enrolled in two prospective cohorts for imaging and biomarker analysis. The imaging cohort (n = 253) underwent echocardiography and cardiac magnetic resonance, and the biomarker cohort (n = 100) blood sampling with multiplex proximity extension assay for 92 proteomic biomarkers. The composite outcome of hospitalization for heart failure admissions and death was assessed in the imaging cohort. RESULTS Diabetic patients were older (70.4 ± 6.8 versus 66.7 ± 10.1 years) with more advanced ventricular diastolic dysfunction and increased replacement and diffuse interstitial fibrosis (late gadolinium enhancement % 0.3 [0.0-1.6] versus 0.0 [0.0-0.5], p = 0.009; extracellular volume fraction % 27.9 [25.7-30.1] versus 26.7 [24.9-28.5], p = 0.025) in the imaging cohort. Plasma proteomics analysis of the biomarker cohort revealed that 9 proteins (E-selectin, interleukin-1 receptor type 1, interleukin-1 receptor type 2, galectin-4, intercellular adhesion molecule 2, integrin beta-2, galectin-3, growth differentiation factor 15, and cathepsin D) were significantly elevated and that pathways related to inflammatory response and extracellular matrix components were enriched in diabetic AS patients. During follow-up (median 6.3 years), there were 53 unexpected heart failure admissions or death in the imaging cohort. Diabetes was a significant predictor of heart failure and death, independent of clinical covariates and aortic valve replacement (HR 1.88, 95% CI 1.06-3.31, p = 0.030). CONCLUSIONS Plasma proteomic analyses indicate that diabetes potentiates the systemic proinflammatory-profibrotic milieu in AS patients. These systemic biological changes underlie the increase of myocardial fibrosis, diastolic dysfunction, and worse clinical outcomes in severe AS patients with concomitant diabetes.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Sahmin Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea.
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20
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Kwak S, Lee SA, Lim J, Yang S, Choi HM, Hwang IC, Lee S, Yoon YE, Park JB, Kim HK, Kim YJ, Song JM, Cho GY, Kim KH, Kang DH, Kim DH, Lee SP. Long-term outcomes in distinct phenogroups of patients with primary mitral regurgitation undergoing valve surgery. Heart 2023; 109:305-313. [PMID: 35882521 PMCID: PMC9887360 DOI: 10.1136/heartjnl-2022-321305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Patients with mitral regurgitation (MR) may be heterogeneous with different risk profiles. We aimed to identify distinct phenogroups of patients with severe primary MR and investigate their long-term prognosis after mitral valve (MV) surgery. METHODS The retrospective cohort of patients with severe primary MR undergoing MV surgery (derivation, n=1629; validation, n=692) was analysed. Latent class analysis was used to classify patients into subgroups using 15 variables. The primary outcome was all-cause mortality after MV surgery. RESULTS During follow-up (median 6.0 years), 149 patients (9.1%) died in the derivation cohort. In the univariable Cox analysis, age, female, atrial fibrillation, left ventricular (LV) end-systolic dimension/volumes, LV ejection fraction, left atrial dimension and tricuspid regurgitation peak velocity were significant predictors of mortality following MV surgery. Five distinct phenogroups were identified, three younger groups (group 1-3) and two older groups (group 4-5): group 1, least comorbidities; group 2, men with LV enlargement; group 3, predominantly women with rheumatic MR; group 4, low-risk older patients; and group 5, high-risk older patients. Cumulative survival was the lowest in group 5, followed by groups 3 and 4 (5-year survival for groups 1-5: 98.5%, 96.0%, 91.7%, 95.6% and 83.4%; p<0.001). Phenogroups had similar predictive performance compared with the Mitral Regurgitation International Database score in patients with degenerative MR (3-year C-index, 0.763 vs 0.750, p=0.602). These findings were reproduced in the validation cohort. CONCLUSION Five phenogroups of patients with severe primary MR with different risk profiles and outcomes were identified. This phenogrouping strategy may improve risk stratification when optimising the timing and type of interventions for severe MR.
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Affiliation(s)
- Soongu Kwak
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Jaehyun Lim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Seokhun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hong-Mi Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (the Republic of)
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Yeonyee Elizabeth Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of),Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of) .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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21
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Choi YJ, Kim D, Rhee TM, Lee HJ, Park JB, Lee SP, Chang SA, Kim YJ, Jeon ES, Oh JK, Choi JO, Kim HK. Left atrial reservoir strain as a novel predictor of new-onset atrial fibrillation in light-chain-type cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2023; 24:751-758. [PMID: 36637873 DOI: 10.1093/ehjci/jeac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS To investigate whether left arterial reservoir strain (LASr) could predict new-onset atrial fibrillation (NOAF) in patients with light-chain-type cardiac amyloidosis (ALCA). METHODS AND RESULTS This study enrolled 427 patients with CA from two tertiary centres between 2005 and 2019. LASr was measured using a vendor-independent analysis programme. The primary outcome was NOAF. A total of 287 patients with ALCA were included [median age 63.0 (56.0-70.0) years, 53.3% male]. The median LASr was 13.9% (10.5-20.8%). During the median follow-up of 0.85 years, AF occurred in 34 patients (11.8%). In the receiver operating characteristics curve analysis, the optimal cut-off of LASr for predicting NOAF was 14.4%. Patients with LASr ≤14.4% had a higher risk of NOAF than those with LASr >14.4% (18.1% vs. 5.1%, P < 0.010). In the multivariate analysis adjusting for confounding factors, including left arterial volume index and left ventricular global longitudinal strain (LV-GLS), higher LASr (%) was independently associated with lower risk for NOAF [adjusted hazard ratio (aHR): 0.936, 95% confidence interval (95% CI): 0.879-0.997, P = 0.039]. Furthermore, LASr ≤14.4% was an independent predictor for NOAF (aHR: 3.370, 95% CI: 1.337-8.492, P = 0.010). This remained true after accounting for all-cause death as a competing risk. Compared with Model 1 (LV-GLS) and Model 2 (LV-GLS plus LAVI), Model 3, including LASr showed a better reclassification ability for predicting NOAF (net reclassification index = 0.735, P < 0.001 compared with Model 1; net reclassification index = 0.514, P = 0.003 compared with Model 2). CONCLUSION LASr was an independent predictor of NOAF in patients with ALCA.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-dong, Guro-gu Seoul 08308, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Tea-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea.,Department of Cardiovascular Medicine, Mayo Clinic, 201 W. Center St., Rochester, MN 55902, USA
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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22
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Park JB, Yun JY, Kim B, Rhee TM, Lee HJ, Lee H, Hwang IC, Yoon YE, Park HE, Lee SP, Choi SY, Kim YJ, Cho GY, Han K, Kim HK. Risk of incident mental disorders in hypertrophic cardiomyopathy: a nationwide propensity-matched study. Eur J Prev Cardiol 2023; 30:85-94. [PMID: 36348515 DOI: 10.1093/eurjpc/zwac260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
AIMS We sought to determine the risk of mental disorders in patients with hypertrophic cardiomyopathy (HCM) compared with those without HCM. METHODS AND RESULTS This is a retrospective propensity score-matched cohort study using nationwide population-based data from the Korean National Health Insurance Service. Overall, 4046 patients with HCM and 12138 matched individuals were followed up until the first diagnosis of mental disorders or the end of the follow up. The primary outcome was a composite of incident mood, anxiety, stress-related, or somatoform disorders. Secondary outcomes included two components of the primary outcome (i.e. mood disorders and anxiety/stress-related/somatoform disorders). During a median follow-up period of 4.1 years, the incidence rate of the primary outcome was 54.4 and 31.5/1000 person-years among the HCM and control groups, respectively, resulting in a hazard ratio (HR) of 1.719 (95% confidence interval: 1.589-1.860). Within the first month after HCM diagnosis, the HR for the primary outcome was 3.074 (2.096-4.508). Beyond 1 month, the HRs decreased, ranging from 2.281 (1.952-2.665) during 1-12 months, to 2.087 (1.831-2.380) during 12-36 months and 1.258 (1.090-1.452) after 36 months of follow up. Similar results were observed for the secondary outcomes. In sensitivity analysis, the risk of the specific categories of mental disorders, including single or recurrent depressive episodes and anxiety disorders, was also higher in patients with HCM than matched controls. CONCLUSION HCM was significantly associated with the risk of incident mental disorders, particularly within 1 year after HCM diagnosis, underscoring the importance of screening mental health problems, including mood and anxiety disorders, in patients with HCM.
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Affiliation(s)
- Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Je-Yeon Yun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bongsung Kim
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
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23
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Kwak S, Lim J, Yang S, Rhee TM, Choi YJ, Lee HJ, Hwang IC, Lee H, Yoon YE, Park HE, Lee SP, Kim HK, Choi SY, Kim YJ, Cho GY, Park JB. Atrial Functional Tricuspid Regurgitation: Importance of Atrial Fibrillation and Right Atrial Remodeling and Prognostic Significance. JACC Cardiovasc Imaging 2023; 16:575-587. [PMID: 36669928 DOI: 10.1016/j.jcmg.2022.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about the determinants and outcomes of significant atrial functional tricuspid regurgitation (AFTR). OBJECTIVES The authors aimed to identify risk factors for significant TR in relation to atrial fibrillation-flutter (AF-AFL) and assess its prognostic implications. METHODS The authors retrospectively studied patients with mild TR with follow-up echocardiography examinations. Significant TR was defined as greater than or equal to moderate TR. AFTR was defined as TR, attributed to right atrial (RA) remodeling or isolated tricuspid annular dilatation, without other primary or secondary etiology, except for AF-AFL. The Mantel-Byar test was used to compare clinical outcomes by progression of AFTR. RESULTS Of 833 patients with mild TR, 291 (34.9%) had AF-AFL. During the median 4.6 years, significant TR developed in 35 patients, including 33 AFTRs. Significant AFTR occurred in patients with AF-AFL more predominantly than in those patients without AF-AFL (10.3% vs 0.6%; P < 0.001). In Cox analysis, AF-AFL was a strong risk factor for AFTR (adjusted HR: 8.33 [95% CI: 2.34-29.69]; P = 0.001). Among patients with AF-AFL, those who developed significant AFTR had larger baseline RA areas (23.8 vs 19.4 cm2; P < 0.001) and RA area-to-right ventricle end-systolic area ratio (3.0 vs 2.3; P < 0.001) than those who did not. These parameters were independent predictors of AFTR progression. The 10-year major adverse cardiovascular event was significantly higher after progression of AFTR than before or without progression (79.8% vs 8.6%; Mantel-Byar P < 0.001). CONCLUSIONS In patients with mild TR, significant AFTR developed predominantly in patients with AF-AFL, conferring poor prognosis. RA enlargement, especially with increased RA area-to-right ventricle end-systolic area ratio, was a strong risk factor for progression of AFTR.
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Affiliation(s)
- Soongu Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaehyun Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seokhun Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Korea University & Korea University Guro Hospital, Seoul, South Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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24
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Kim BJ, Cha KS, Cho WH, Kim EJ, Choi SH, Kim MH, Kim SH, Park JB, Park SM, Sohn IS, Ryu KH, Chae IH. Efficacy and Safety of a Single-Pill Triple Combination of Olmesartan, Amlodipine, and Rosuvastatin in Hypertensive Patients with Low-to-Moderate Cardiovascular Risk: A Multicenter, Randomized, Open-Label, Active-Control, Phase IV Clinical Trial. J Cardiovasc Pharmacol Ther 2023; 28:10742484231205204. [PMID: 37814541 DOI: 10.1177/10742484231205204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This study evaluated the efficacy and safety of a single-pill triple-combination of olmesartan/amlodipine/rosuvastatin (Olme/Amlo/Rosu) in comparison with a single-pill dual-combination of olmesartan/amlodipine (Olme/Amlo) in hypertensive patients with low-to-moderate cardiovascular risk. METHODS This multicenter, active-control, randomized study included 106 hypertensive patients at low-to-moderate cardiovascular risk who were randomly assigned to receive either Olme/Amlo/Rosu 20/5/5 mg (Treatment 1), Olme/Amlo/Rosu 20/5/10 mg (Treatment 2), or Amlo/Olme 20/5 mg (Control) once daily for 8 weeks. The primary endpoint was the difference of the percent change in low-density lipoprotein cholesterol (LDL-C) level at 8 weeks from baseline in the 3 groups. RESULTS The difference in the least square mean percent change (standard deviation) of LDL-C in the Treatment 1 and 2 groups compared with the Control group at 8 weeks was -32.6 (3.7) % and -45.9 (3.3) %, respectively (P < .001). The achievement rates of LDL-C level <100 mg/dL at 8 weeks were significantly different between the 3 groups (65.8%, 86.7%, and 6.3% for Treatment 1, 2, and Control groups, respectively, P < .001). The results of total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 were superior in the Treatment 1 and 2 groups compared with the Control group. Serious adverse drug reaction did not occur in the 3 groups. Medication adherence rates were excellent in the 3 groups (98.0% for Treatment 1 group, 99.7% for Treatment 2 group, and 96.3% for the Control group, P > .05). CONCLUSION Single-pill triple-combination of olmesartan/amlodipine/rosuvastatin was superior to the single-pill dual-combination of amlodipine/olmesartan in LDLC-lowering effects, with excellent safety profiles and adherence rates, in hypertensive patients at low-to-moderate cardiovascular risk.Trial Registration: CLinicalTrials.gov identifier NCT04120753.
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Affiliation(s)
- Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Soo Cha
- Department of Internal Medicine and Medial Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Wook Hyun Cho
- Department of Cardiology, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Eung Ju Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Department of Cardiology, Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kyu Hyung Ryu
- Department of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University, Bundang Hospital, Gyeonggi-do, Republic of Korea
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25
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Choi YJ, Son JW, Kim EK, Kim IC, Kim HY, Seo JS, Sun BJ, Shim CY, Yoon SJ, Lee S, Lee SH, Park JB, Kang DH. Epidemiologic Profile of Patients With Valvular Heart Disease in Korea: A Nationwide Hospital-Based Registry Study. J Cardiovasc Imaging 2023; 31:51-61. [PMID: 36693346 PMCID: PMC9880350 DOI: 10.4250/jcvi.2022.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Valvular heart disease (VHD) is a common cause of cardiovascular morbidity and mortality worldwide; however, its epidemiological profile in Korea requires elucidation. METHODS In this nationwide retrospective cohort study from the Korean valve survey, which collected clinical and echocardiographic data on VHD from 45 medical centers, we identified 4,089 patients with VHD between September and October 2019. RESULTS The aortic valve was the most commonly affected valve (n = 1,956 [47.8%]), followed by the mitral valve (n = 1,598 [39.1%]) and tricuspid valve (n = 1,172 [28.6%]). There were 1,188 cases of aortic stenosis (AS) and 926 cases of aortic regurgitation. The most common etiology of AS was degenerative disease (78.9%). The proportion of AS increased with age and accounted for the largest proportion of VHD in patients aged 80-89 years. There were 1,384 cases of mitral regurgitation (MR) and 244 cases of mitral stenosis (MS). The most common etiologies for primary and secondary MR were degenerative disease (44.3%) and non-ischemic heart disease (63.0%), respectively, whereas rheumatic disease (74.6%) was the predominant cause of MS. There were 1,172 tricuspid regurgitation (TR) cases, of which 46.9% were isolated and 53.1% were associated with other valvular diseases, most commonly with MR. The most common type of TR was secondary (90.2%), while primary accounted for 6.1%. CONCLUSIONS This report demonstrates the current epidemiological status of VHD in Korea. The results of this study can be used as fundamental data for developing Korean guidelines for VHD.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, Seoul, Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University, Busan, Korea
| | - Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sahmin Lee
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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Choi YJ, Kim HK, Hwang IC, Park CS, Rhee TM, Lee HJ, Park JB, Yoon YE, Lee SP, Cho GY, Kim YJ. Prognosis of patients with hypertrophic cardiomyopathy and low-normal left ventricular ejection fraction. Heart 2022; 109:771-778. [PMID: 36581445 DOI: 10.1136/heartjnl-2022-321853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate whether low-normal left ventricular ejection fraction (LVEF) is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM) and evaluate the incremental value of predictive power of LVEF in the conventional HCM sudden cardiac death (SCD)-risk model. METHODS This retrospective study included 1858 patients with HCM from two tertiary hospitals between 2008 and 2019. We classified LVEF into three categories: preserved (≥60%), low normal (50%-60%) and reduced (<50%); there were 1399, 415, and 44 patients with preserved, low-normal, and reduced LVEF, respectively. The primary outcome was a composite of SCD, ventricular tachycardia/fibrillation and appropriate implantable cardioverter-defibrillator shocks. Secondary outcomes were hospitalisation for heart failure (HHF), cardiovascular death and all-cause death. RESULTS During the median follow-up of 4.09 years, the primary outcomes occurred in 1.9%. HHF, cardiovascular death, and all-cause death occurred in 3.3%, 1.9%, and 5.3%, respectively. Reduced LVEF was an independent predictor of SCD/equivalent events (adjusted HR (aHR) 5.214, 95% CI 1.574 to 17.274, p=0.007), adding predictive value to the HCM risk-SCD model (net reclassification improvement 0.625). Compared with patients with HCM with preserved LVEF, those with low-normal and reduced LVEF had a higher risk of HHF (LVEF 50%-60%, aHR 2.457, 95% CI 1.423 to 4.241, p=0.001; LVEF <50%, aHR 7.937, 95% CI 3.315 to 19.002, p<0.001) and cardiovascular death (LVEF 50%-60%, aHR 2.641, 95% CI 1.314 to 5.309, p=0.006; LVEF <50%, aHR 5.405, 95% CI 1.530 to 19.092, p=0.009), whereas there was no significant association with all-cause death. CONCLUSIONS Low-normal LVEF was an independent predictor of HHF and cardiovascular death in patients with HCM.
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Affiliation(s)
- You-Jung Choi
- Internal Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of).,Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of) .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - In-Chang Hwang
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of) .,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Yeonyee Elizabeth Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Goo-Yeong Cho
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Yong-Jin Kim
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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27
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Park CS, Kim SH, Yang HY, Kim JH, Schermuly RT, Cho YS, Kang H, Park JH, Lee E, Park H, Yang JM, Noh TW, Lee SP, Bae SS, Han J, Ju YS, Park JB, Kim I. Sox17 Deficiency Promotes Pulmonary Arterial Hypertension via HGF/c-Met Signaling. Circ Res 2022; 131:792-806. [PMID: 36205124 PMCID: PMC9612711 DOI: 10.1161/circresaha.122.320845] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In large-scale genomic studies, Sox17, an endothelial-specific transcription factor, has been suggested as a putative causal gene of pulmonary arterial hypertension (PAH); however, its role and molecular mechanisms remain to be elucidated. We investigated the functional impacts and acting mechanisms of impaired Sox17 (SRY-related HMG-box17) pathway in PAH and explored its potential as a therapeutic target. METHODS In adult mice, Sox17 deletion in pulmonary endothelial cells (ECs) induced PAH under hypoxia with high penetrance and severity, but not under normoxia. RESULTS Key features of PAH, such as hypermuscularization, EC hyperplasia, and inflammation in lung arterioles, right ventricular hypertrophy, and elevated pulmonary arterial pressure, persisted even after long rest in normoxia. Mechanistically, transcriptomic profiling predicted that the combination of Sox17 deficiency and hypoxia activated c-Met signaling in lung ECs. HGF (hepatocyte grow factor), a ligand of c-Met, was upregulated in Sox17-deficient lung ECs. Pharmacologic inhibition of HGF/c-Met signaling attenuated and reversed the features of PAH in both preventive and therapeutic settings. Similar to findings in animal models, Sox17 levels in lung ECs were repressed in 26.7% of PAH patients (4 of 15), while those were robust in all 14 non-PAH controls. HGF levels in pulmonary arterioles were increased in 86.7% of patients with PAH (13 of 15), but none of the controls showed that pattern. CONCLUSIONS The downregulation of Sox17 levels in pulmonary arterioles increases the susceptibility to PAH, particularly when exposed to hypoxia. Our findings suggest the reactive upregulation of HGF/c-Met signaling as a novel druggable target for PAH treatment.
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Affiliation(s)
- Chan Soon Park
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.).,Division of Cardiology, Department of Internal Medicine (C.S.P., Y.S.C., H.K., S.-P.L., J.-B.P.)
| | - Soo Hyun Kim
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - Hae Young Yang
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - Ju-Hee Kim
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - Ralph Theo Schermuly
- Department of Internal Medicine, Justus-Liebig University Giessen, Member of the German Center for Lung Research (DZL), Germany (R.T.S.)
| | - Ye Seul Cho
- Division of Cardiology, Department of Internal Medicine (C.S.P., Y.S.C., H.K., S.-P.L., J.-B.P.)
| | - Hyejeong Kang
- Division of Cardiology, Department of Internal Medicine (C.S.P., Y.S.C., H.K., S.-P.L., J.-B.P.).,Center for Precision Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Republic of Korea (H.K., S.-P.L.)
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea (J.-H.P.)
| | - Eunhyeong Lee
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - HyeonJin Park
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - Jee Myung Yang
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.).,Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea (J.MY.)
| | - Tae Wook Noh
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.)
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine (C.S.P., Y.S.C., H.K., S.-P.L., J.-B.P.).,Center for Precision Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Republic of Korea (H.K., S.-P.L.).,Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea (S.-P.L.)
| | - Sun Sik Bae
- Department of Pharmacology, Pusan National University School of Medicine, Busan, Republic of Korea (S.S.B.)
| | - Jinju Han
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.).,Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea (J.H., Y.S.J., I.K.)
| | - Young Seok Ju
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.).,Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea (J.H., Y.S.J., I.K.)
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine (C.S.P., Y.S.C., H.K., S.-P.L., J.-B.P.)
| | - Injune Kim
- Graduate School of Medical Science and Engineering (C.S.P., S.H.K., H.Y.Y., J.-H.K., E.L., H.P., J.M.Y., T.W.N., J.H., Y.S.J., I.K.).,Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea (J.H., Y.S.J., I.K.)
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Lee HJ, Park CS, Lee S, Park JB, Kim HK, Park SJ, Kim YJ, Lee SP. Systemic proinflammatory-profibrotic response in aortic stenosis patients with diabetes and its relationship with myocardial remodeling and clinical outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It is unclear whether and how diabetes mellitus may aggravate myocardial fibrosis and remodeling in the pressure-overloaded heart. We investigated the impact of diabetes on the prognosis of aortic stenosis (AS) patients and its underlying mechanisms using comprehensive noninvasive imaging studies and plasma proteomics.
Methods
Severe AS patients undergoing both echocardiography and cardiovascular magnetic resonance (CMR) (n=253 of which 66 had diabetes) comprised the imaging cohort. The degree of replacement and diffuse interstitial fibrosis by late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) was quantified using CMR. Plasma samples were analyzed with the multiplex proximity extension assay for 92 proteomic biomarkers in a separate biomarker cohort of severe AS patients (n=100 of which 27 had diabetes).
Results
In the imaging cohort, diabetic patients were older (70.4±6.8 vs. 66.7±10.1 years) and had a higher prevalence of ischemic heart disease (28.8% vs. 9.1%), with more advanced ventricular diastolic dysfunction. On CMR, diabetic patients had increased replacement and diffuse interstitial fibrosis (LGE% 0.3 [0.0–1.6] versus 0.0 [0.0–0.5], p=0.009; ECV% 27.9 [25.7–30.1] versus 26.7 [24.9–28.5], p=0.025) (Figure 1).
Plasma proteomics analysis of the biomarker cohort revealed that 9 proteins (E-selectin, interleukin-1 receptor type 1, interleukin-1 receptor type 2, galectin-4, intercellular adhesion molecule 2, integrin beta-2, galectin-3, growth differentiation factor 15, and cathepsin D) are significantly elevated in diabetic AS patients (Figure 2). Pathway over-representation analyses of the plasma proteomics with Gene Ontology terms indicated that pathways related to inflammatory response and extracellular matrix components were enriched, suggesting that diabetes is associated with systemic effects that evoke proinflammatory and profibrotic response to the pressure-overloaded myocardium.
During follow-up (median 6.3 years [IQR 5.2–7.2]) of the imaging cohort, 232 patients received aortic valve replacement (AVR) with 53 unexpected heart failure admissions or death. Diabetes was a significant predictor of heart failure and death, independent of clinical covariates and AVR (hazard ratio 1.88, 95% confidence interval 1.06–3.31, p=0.030).
Conclusion
Plasma proteomic analyses indicate that diabetes potentiates the systemic proinflammatory and profibrotic milieu in AS patients. These systemic biological changes underlie the increase of myocardial fibrosis, diastolic dysfunction, and worse clinical outcomes in severe AS patients with concomitant diabetes.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Research Foundation of Korea
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Affiliation(s)
- H J Lee
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
| | - C S Park
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
| | - S Lee
- Asan Medical Center, Internal Medicine , Seoul , Korea (Republic of)
| | - J B Park
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
| | - H K Kim
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
| | - S J Park
- Samsung Medical Center, Cardiovascular Imaging Center , Seoul , Korea (Republic of)
| | - Y J Kim
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
| | - S P Lee
- Seoul National University Hospital, Internal Medicine , Seoul , Korea (Republic of)
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Choi YJ, Kim BS, Rhee TM, Lee HJ, Lee H, Park JB, Lee SP, Han KD, Kim YJ, Hk KIM. Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ischemic stroke is a common complication in patients with hypertrophic cardiomyopathy (HCM) (1). Although atrial fibrillation (AF) is a well-established risk factor for ischemic stroke in HCM, the risk of ischemic stroke in patients with HCM without documented AF is less recognized (1, 2). This study aimed to determine the risk of ischemic stroke and identify its risk factors in patients with HCM without documented AF.
Methods
This nationwide population-based cohort study used the Korean National Health Insurance database. After excluding patients with a prior history of AF, thromboembolic events, cancer, or the use of anticoagulants, we identified 8,328 HCM patients without documented AF and 1:2 propensity score-matched 16,656 non-HCM controls. The clinical outcome was an incident ischemic stroke.
Results
During a mean follow-up of approximately 6 years, ischemic stroke occurred in 328/8,328 (3.9%) patients with HCM and 443/16,656 (2.7%) controls. Among individuals who developed ischemic stroke, the proportion of AF concomitantly detected accounted for 26.5% (87/328) and 5.8% (26/443) in the HCM and control groups, respectively. The overall incidence of ischemic stroke was 0.716/100 person-years in the HCM group, which was significantly higher than that in the control group (0.44/100 person-years) (HR 1.643; 95% CI, 1.424–1.895; P<0.001, Figure 1). The subgroup analysis according to age, sex, and comorbidities (chronic heart failure, hypertension, dyslipidemia, and vascular disease) consistently demonstrated a higher risk of ischemic stroke in the HCM group (P for interaction >0.05). In the HCM group, age ≥65 years (adjusted hazard ratio [HR] 2.741; 95% confidence interval [CI], 2.156–3.486; P<0.001) and chronic heart failure (adjusted HR 1.748; 95% CI, 1.101–2.745; P=0.018) were independent risk factors for ischemic stroke. Overall incidence was 1.360/100 in patients with HCM aged ≥65 and 2.315/100 person-years years in those with chronic heart failure, respectively. Also, compared to controls aged <65 years and without CHF, adjusted HR for ischemic stroke was 4.756 (95% CI 3.807–5.867) in patients with HCM aged ≥65 years and 2.539 (95% CI 1.638–3.936) in those with CHF, respectively (Figure 2).
Conclusions
Patients with HCM without documented AF are at a higher risk of ischemic stroke than the propensity score-matched general population. Age ≥65 years and chronic heart failure are two strong independent risk factors for ischemic stroke in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y J Choi
- Korea University Guro Hospital , Seoul , Korea (Democratic People's Republic of)
| | - B S Kim
- The Catholic University of Korea , Seoul , Korea (Republic of)
| | - T M Rhee
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - H J Lee
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - H Lee
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - J B Park
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - S P Lee
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - K D Han
- The Catholic University of Korea , Seoul , Korea (Republic of)
| | - Y J Kim
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
| | - K I M Hk
- Seoul National University Hospital, Internal medicine , Seoul , Korea (Republic of)
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30
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Rhee TM, Kim HK, Choi YJ, Lee HJ, Hwang IC, Yoon YE, Kim HL, Park JB, Lee SP, Kim YJ, Cho GY. Agreement of two vendor-independent strain analysis software platforms in assessing left ventricular global longitudinal strain. Int J Cardiovasc Imaging 2022; 38:1939-1950. [PMID: 37726615 DOI: 10.1007/s10554-022-02589-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The new version of EchoPAC platform was recently developed by General Electronics (GE) to provide 'vendor-independent' full-myocardial-layer left ventricular (LV) global longitudinal strain (LV-GLS). The agreement of the LV-GLS by two vendor-independent software platforms was investigated under diverse clinical situations. METHODS Two-dimensional speckle-tracking LV-GLS was separately measured by two software platforms. LV-GLS values were compared as default setting of each software platform (GE full-myocardial-layer [GE-Full], and TomTec endocardial-layer [TomTec-Endo]). Agreements according to various conditions and type of echocardiography vendors were evaluated using Bland-Altman analysis and intraclass correlation coefficients (ICC). Inter-observer reproducibility of each software platform was assessed, and agreements were further evaluated in various subgroups. RESULTS One hundred five subjects were initial candidates for the current study (normal LV function without any cardiac pathology [n = 25], hypertrophic cardiomyopathy [n = 40], dilated cardiomyopathy [n = 25], or restrictive cardiomyopathy [n = 15]). After excluding seven subjects with inadequate tracking quality, 98 subjects were finally analyzed. The average LV-GLS was lower in GE-Full than in TomTec-Endo. Agreement between GE-Full and TomTec-Endo was excellent in general; while the greatest bias was observed in the hypertrophic cardiomyopathy group, with TomTec-Endo exhibiting greater LV-GLS values than GE-Full (bias -1.71, limits of agreement -6.02 to 2.59). Both platforms showed excellent inter-observer reproducibility (GE-Full, ICC 0.99; TomTec-Endo, ICC 0.91), and were in good agreements regardless of the echocardiography vendors or subgroups according to age, heart rate, myocardial wall thickness, or LV ejection fraction. CONCLUSIONS LV-GLS by GE-Full showed excellent agreement with that by TomTec-Endo under various cardiac conditions.
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Affiliation(s)
- Tae-Min Rhee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Professor and Director of Cardiac Diagnostic Test Unit, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea.
| | - You-Jung Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Chang Hwang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yeonyee E Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
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Kim JW, Ryu H, Park JB, Moon SH, Myung SJ, Park WB, Yim JJ, Yoon HB. How to enhance students' learning in a patient-centered longitudinal integrated clerkship: factors associated with students' learning experiences. Korean J Med Educ 2022; 34:201-212. [PMID: 36070990 PMCID: PMC9452371 DOI: 10.3946/kjme.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/13/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Longitudinal integrated clerkships (LICs) have been introduced in medical schools, as learning relationships with clinical faculty or peers are important components of medical education. The purpose of this study was to investigate the characteristics of student-faculty and student-student interactions in the LIC and to identify other factors related to whether students understood and acquired the program's main outcomes. METHODS The study was conducted among the 149 third-year students who participated in the LIC in 2019. We divided the students into groups of eight. These groups were organized into corresponding discussion classes, during which students had discussions with clinical faculty members and peers and received feedback. Clinical faculty members and students were matched through an e-portfolio, where records were approved and feedback was given. A course evaluation questionnaire was completed and analysed. RESULTS A total of 144 valid questionnaires were returned. Logistic regression analysis showed that relevant feedback in discussion classes (adjusted odds ratio [AOR], 5.071; p<0.001), frequency of e-portfolio feedback (AOR, 1.813; p=0.012), and motivation by e-portfolio feedback (AOR, 1.790; p=0.026) predicted a greater likelihood of understanding the continuity of the patient's medical experience. Relevant feedback from faculty members in discussion classes (AOR, 3.455; p<0.001) and frequency of e-portfolio feedback (AOR, 2.232; p<0.001) also predicted a greater likelihood of understanding the concept of patient-centered care. CONCLUSION Student-faculty interactions, including relevant feedback in discusstion classes, frequency of e-portfolio feedback, and motivation by e-portfolio feedback were found to be important factors in the LIC program.
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Affiliation(s)
- Ju Whi Kim
- Office of Medical Education, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Sang Hui Moon
- Office of Medical Education, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun Jung Myung
- Office of Medical Education, Seoul National University College of Medicine, Seoul,
Korea
| | - Wan Beom Park
- Office of Medical Education, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Jae-Joon Yim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul,
Korea
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Park JJ, Hwang IC, Kang SH, Park JB, Park JH, Cho GY. Myocardial strain for heart failure with preserved ejection fraction but without diastolic dysfunction. ESC Heart Fail 2022; 9:3308-3316. [PMID: 35821568 DOI: 10.1002/ehf2.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS Some patients with apparent heart failure (HF) have an ejection fraction (EF) ≥ 50% and elevated levels of natriuretic peptides (NPs), but no significant diastolic dysfunction. Among these, some may have HF, others may not. Myocardial strain is an excellent prognostic factor. METHODS AND RESULTS Among 4312 consecutive patients with acute HF from three tertiary hospitals, we included 355 patients with EF of ≥50% and elevated levels of NPs, without significant diastolic dysfunction. Patients were classified as having impaired global longitudinal strain (GLS < 16%) or normal GLS (GLS ≥ 16%). The primary endpoint was 5 year all-cause mortality. The mean age was 70.3 years and 49% were female. Overall, 107 patients (30.1%) died at 5 years. As per the definition, 176 (49.6%) patients had impaired GLS and 179 (50.4%) had normal GLS. Patients with normal GLS had lower 5 year all-cause mortality than those with impaired GLS (P < 0.001). When comparing with the 11 365 age-matched and sex-matched controls, patients with normal GLS had the same long-term survival as the controls (P = 0.834), whereas those with impaired GLS had 48% increased risk of all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.17-1.89). CONCLUSIONS Among patients with apparent HF and preserved EF but without diastolic dysfunction, those with impaired GLS may be considered to have HF.
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Affiliation(s)
- Jin Joo Park
- Cardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Choi YJ, Koh Y, Lee HJ, Hwang IC, Park JB, Yoon YE, Kim HL, Kim HK, Kim YJ, Cho GY, Sohn DW, Paeng JC, Lee SP. Independent Prognostic Utility of 11C-Pittsburgh Compound B PET in Patients with Light-Chain Cardiac Amyloidosis. J Nucl Med 2022; 63:1064-1069. [PMID: 34916248 PMCID: PMC9258564 DOI: 10.2967/jnumed.121.263033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/09/2021] [Indexed: 01/03/2023] Open
Abstract
11C-Pittsburgh compound B (PiB) PET/CT visualizes the amount of myocardial amyloid deposit and can be used to prognosticate patients with amyloid light-chain (AL) cardiac amyloidosis (CA). However, whether 11C-PiB PET/CT has any independent additional prognostic value beyond the commonly used biomarkers remains unknown. Methods: This prospective study was on a cohort of 58 consecutive patients with AL CA who underwent 11C-PiB PET/CT. The patients were stratified into 2 groups on the basis of a visual assessment of whether there was myocardial 11C-PiB uptake on PET/CT. The primary endpoint was 1-y overall mortality. The independent prognostic utility of 11C-PiB PET/CT was analyzed using net reclassification improvement and integrated discrimination improvement. Results: Among the 58 patients enrolled, 35 were positive for myocardial 11C-PiB uptake on PET/CT. Patients with myocardial 11C-PiB PET uptake had a worse 1-y overall survival rate than those without (81.8% vs. 45.5%, P = 0.003 by log-rank test). In the multivariate analysis, positivity for myocardial 11C-PiB uptake on PET/CT was an independent predictor of 1-y mortality (adjusted hazard ratio, 3.382; 95% CI, 1.011-11.316; P = 0.048). In analysis of 3 subgroups of patients-those with a troponin I level of at least 0.1 ng/mL, those with an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of at least 1,800 pg/mL, and those with a difference of at least 180 mg/L between free light chains (the 3 commonly used biomarkers and their thresholds for staging in AL amyloidosis)-Kaplan-Meier curves showed for all 3 subgroups that patients positive for myocardial 11C-PiB uptake on PET/CT had a worse prognosis than those who were negative. Additionally, when the results of 11C-PiB PET/CT were added to these 3 biomarkers, the performance of 1-y mortality prediction significantly improved by net reclassification improvement (troponin I, 0.861; NT-proBNP, 0.914; difference between free light chains, 0.987) and by integrated discrimination improvement (0.200, 0.156, and 0.108, respectively). Conclusion:11C-PiB PET/CT is a strong independent predictor of 1-y overall mortality and provides incremental prognostic benefits beyond the 3 commonly used biomarkers of AL amyloidosis staging. Considering the recent development of numerous amyloid-targeting molecular imaging agents, further investigations are warranted on whether PET/CT should be included in risk stratification for patients with AL CA.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Youngil Koh
- Division of Hemato Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - In-Chang Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonyee E. Yoon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea;,Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea; and
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dae-Won Sohn
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Park J, Hwang IC, Yoon YE, Park JB, Park JH, Cho GY. Predicting Long-Term Mortality in Patients With Acute Heart Failure by Using Machine Learning. J Card Fail 2022; 28:1078-1087. [PMID: 35301108 DOI: 10.1016/j.cardfail.2022.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/19/2022] [Accepted: 02/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND High mortality rates in patients with acute heart failure (AHF) necessitate proper risk stratification. However, risk-assessment tools for long-term mortality are largely lacking. We aimed to develop a machine-learning (ML)-based risk-prediction model for long-term all-cause mortality in patients admitted for AHF. METHODS AND RESULTS The ML model, based on boosted a Cox regression algorithm (CoxBoost), was trained with 2704 consecutive patients hospitalized for AHF (median age 73 years, 55% male, and median left ventricular ejection fraction 38%). We selected 27 input variables, including 19 clinical features and 8 echocardiographic parameters, for model development. The best-performing model, along with pre-existing risk scores (BIOSTAT-CHF and AHEAD scores), was validated in an independent test cohort of 1608 patients. During the median 32 months (interquartile range 12-54 months) of the follow-up period, 1050 (38.8%) and 690 (42.9%) deaths occurred in the training and test cohorts, respectively. The area under the receiver operating characteristic curve (AUROC) of the ML model for all-cause mortality at 3 years was 0.761 (95% CI: 0.754-0.767) in the training cohort and 0.760 (95% CI: 0.752-0.768) in the test cohort. The discrimination performance of the ML model significantly outperformed those of the pre-existing risk scores (AUROC 0.714, 95% CI 0.706-0.722 by BIOSTAT-CHF; and 0.681, 95% CI 0.672-0.689 by AHEAD). Risk stratification based on the ML model identified patients at high mortality risk regardless of heart failure phenotypes. CONCLUSIONS The ML-based mortality-prediction model can predict long-term mortality accurately, leading to optimal risk stratification of patients with AHF.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
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Lee HJ, Kim HK, Han KD, Lee KN, Park JB, Lee H, Lee SP, Kim YJ. Age-dependent associations of body mass index with myocardial infarction, heart failure, and mortality in over 9 million Koreans. Eur J Prev Cardiol 2022; 29:1479-1488. [PMID: 35580584 DOI: 10.1093/eurjpc/zwac094] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND While obesity is a well-known cardiovascular risk factor, little is known whether age has a modifying effect. AIM To determine the age-dependent associations of BMI with cardiovascular outcomes. METHODS A population-based cohort of 9,278,433 Koreans without prior cardiovascular disease were followed up for the incidence of myocardial infarction (MI), heart failure (HF), and all-cause death. The effect of BMI with optimal normal weight (18.5-22.9 kg/m2) as reference was analyzed according to age groups [young (20-39 years), middle-aged (40-64 years), and elderly (≥65 years)] and age decades. RESULTS During 8.2 years, MI, HF, and all-cause death occurred in 65,607 (0.71%), 131,903 (1.42%), and 306,065 (3.30%), respectively. Associations between BMI and all outcomes were significantly modified by age (p-for-interaction < 0.001). There was a proportional increase in incident MI according to BMI in young subjects; this relationship became U-shaped in middle-aged subjects, and inversely proportional/plateauing in elderly subjects. A U-shaped relationship between BMI and incident HF was observed, but the impact of obesity was stronger in young subjects while the impact of underweight was stronger in middle-aged and elderly subjects. Meanwhile, lower BMI was associated with higher all-cause mortality in all ages, although this association was attenuated at young age, and pre-obesity was associated with the greatest survival benefit. These associations were independent of sex, smoking, physical activity, and comorbidities. CONCLUSIONS The impact of BMI on cardiovascular risk differs according to age. Weight loss may be recommended for younger overweight subjects, while being mildly overweight may be beneficial at old age.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyu-Na Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Korea
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Yoo SH, Sim JA, Shin J, Keam B, Park JB, Shin A. The Impact of COVID-19 on Cancer Care in a Tertiary Hospital in Korea: Possible Collateral Damage to Emergency Care. Epidemiol Health 2022; 44:e2022044. [PMID: 35538696 DOI: 10.4178/epih.e2022044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives We investigated the impact of the COVID-19 pandemic on cancer care in a tertiary hospital of South Korea without the specific lockdown measures. Methods A retrospective cohort of cancer patients from one of the largest tertiary hospitals in South Korea was used to compare the healthcare utilization in different settings (outpatient clinic, emergency department (ED), and admission) between the period of January 1 and December 31, 2020 and the same time period in 2019. The percent changes in healthcare utilization between two periods were calculated. Results A total of 448,833 cases from the outpatient cohort, 26,781 cases from the ED cohort, and 14,513 cases from the admission cohort were reviewed for 2019 and 2020. The total number of ED visit cases significantly decreased in 2020 than in 2019 by 18.04%, whereas the proportion of cancer patients maintained. The reduction in ED visits was more prominent in cases with COVID-19 suspicious symptoms, with high acuity, and those who lived in non-capital city area. There were no significant changes in the number of total visits and new cases in the outpatient clinic between two periods. No significant differences in the total number of hospitalizations were observed between two periods. Conclusion During the pandemic, the number of ED visits significantly decreased, while the use of outpatient clinic and hospitalizations were not affected. Cancer patients' ED visits decreased after the COVID-19 outbreak, suggesting the potential for collateral damage outside the hospital if the ED could not be reached in a timely manner.
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Affiliation(s)
- Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Korea
| | - Jeongmi Shin
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Park CS, Choi YJ, Rhee TM, Lee HJ, Lee HS, Park JB, Kim YJ, Han KD, Kim HK. U-Shaped Associations Between Body Weight Changes and Major Cardiovascular Events in Type 2 Diabetes Mellitus: A Longitudinal Follow-up Study of a Nationwide Cohort of Over 1.5 Million. Diabetes Care 2022; 45:1239-1246. [PMID: 35263435 DOI: 10.2337/dc21-2299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite the benefits of weight loss on metabolic profiles in patients with type 2 diabetes mellitus (T2DM), its association with myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause death remains elusive. RESEARCH DESIGN AND METHODS Using the National Health Insurance Service Database, we screened subjects who underwent general health checkups twice in a 2-year interval between 2009 and 2012. After identifying 1,522,241 patients with T2DM without a previous history of MI, IS, AF, and HF, we followed them until December 2018. Patients were stratified according to the magnitude of weight changes between two general health checkups: ≤ -10%, -10 to ≤ -5%, -5 to ≤5%, 5 to ≤10%, and >10%. RESULTS During the follow-up (median 7.0 years), 32,106 cases of MI, 44,406 cases of IS, 34,953 cases of AF, 68,745 cases of HF, and 84,635 all-cause deaths occurred. Patients with weight changes of -5 to ≤5% showed the lowest risk of each cardiovascular event. Both directions of weight change were associated with an increased cardiovascular risk. Stepwise increases in the risks of MI, IS, AF, HF, and all-cause death were noted with progressive weight gain (all P < 0.0001). Similarly, the more weight loss occurred, the higher the cardiovascular risks observed (all P < 0.0001). The U-shaped associations were consistently observed in both univariate and multivariate analyses. Explorative subgroup analyses also consistently showed a U-shaped association. CONCLUSIONS Both weight loss and gain >5% within a 2-year interval were associated with an increased risk of major cardiovascular events in patients with T2DM.
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Affiliation(s)
- Chan Soon Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - You-Jung Choi
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Sun Lee
- Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Lee HJ, Kim HK, Rhee TM, Choi YJ, Hwang IC, Yoon YE, Park JB, Lee SP, Kim YJ, Cho GY. Left Atrial Reservoir Strain-Based Left Ventricular Diastolic Function Grading and Incident Heart Failure in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e013556. [PMID: 35439039 DOI: 10.1161/circimaging.121.013556] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The echocardiographic assessment of left ventricular (LV) diastolic dysfunction (LVDD) in patients with hypertrophic cardiomyopathy is complex and not well-established. We investigated whether the left atrial reservoir strain (LARS) could be used to categorize LVDD and whether this grading is predictive of heart failure (HF) events in hypertrophic cardiomyopathy. METHODS A total of 414 patients with hypertrophic cardiomyopathy (aged 58.3±12.8 years; 65.7% male) were categorized using LARS-defined LVDD (LARS-DD) grades: ≥35% (grade 0), ≥24% to <35%, ≥19% to <24%, and <19% (grade 3). Patients were followed for a median of 6.9 years to assess hospitalization for HF or HF-related death. RESULTS An increase in LARS-DD grade was associated with worse conventional echocardiographic parameters of LVDD, such as lower e', higher E/e' ratio, greater maximum tricuspid regurgitation velocity, and restrictive mitral inflow pattern. Higher LARS-DD grade was also associated with parameters reflecting increased LV filling pressure, such as greater LV wall thickness, greater extent of fibrosis, obstructive physiology, and decreased LV longitudinal strain. Furthermore, higher LARS-DD grade was associated with worse HF-free survival (log-rank P<0.001). Patients with LARS-DD grades 0, 1, 2, and 3 showed 10-year HF-free survival of 100%, 91.6%, 84.1%, and 67.5%, respectively. LARS-DD grade was an independent predictor of HF events after adjusting for clinical and echocardiographic variables (hazard ratio, 1.53 [95% CI, 1.03-2.28], per 1-grade increase). The LARS-DD grade also had incremental prognostic value for incident HF events over the traditional echocardiographic LVDD parameters and grading system. The prognostic value of advanced LARS-DD grade was consistent in sensitivity analyses and various patient subgroups. CONCLUSIONS LARS can be used as a simple single or supplemental index to categorize LV diastolic function and predict HF events in hypertrophic cardiomyopathy.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
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Lee HJ, Kim HK, Kim BS, Han KD, Rhee TM, Park JB, Lee H, Lee SP, Kim YJ. Impact of diabetes mellitus on the outcomes of subjects with hypertrophic cardiomyopathy: A nationwide cohort study. Diabetes Res Clin Pract 2022; 186:109838. [PMID: 35314254 DOI: 10.1016/j.diabres.2022.109838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
AIMS Diabetes mellitus (DM) often coexists in elderly hypertrophic cardiomyopathy (HCM) patients; however, its impact on clinical outcomes is unclear. METHODS We compared clinical outcomes according to the presence of DM in a nationwide HCM cohort. RESULTS In 9,883 HCM subjects (mean age 58.5 ± 13.1, men 71.7%), 1,327 (13.4%) had DM. During follow-up (mean 5.9 ± 2.5 years), end-stage renal disease (ESRD) progression, coronary events (myocardial infarction, coronary revascularization), heart failure (HF), cardiovascular mortality, and all-cause mortality occurred in 80 (0.8%), 365 (3.7%), 1,558 (15.8%), 354 (3.6%), and 877 (8.9%) subjects, respectively. DM HCM subjects had significantly higher risks of ESRD progression (HR 3.49, 95% CI 2.20-5.54) and HF (HR 1.15, 95% CI 1.01-1.32) compared to non-DM HCM subjects, independent of age, sex, ischemic heart disease, atrial fibrillation, and other comorbidities. There was a tendency for greater risk of ESRD progression, HF, and all-cause death in subjects with more advanced stage of DM (p-for-trend < 0.05 for all). Insulin-treated DM was associated with the highest risk. CONCLUSIONS DM HCM subjects have higher risk of ESRD progression and HF. Considering the extended life expectancy of HCM and increasing number of elderly HCM subjects, active surveillance and management of DM-related outcomes should be highlighted.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
| | - Bong-Seong Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul, South Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul, South Korea
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152, Teheran-ro, Gangnam-gu, Seoul, South Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
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Choi YJ, Kim B, Lee HJ, Lee H, Park JB, Lee SP, Han K, Kim YJ, Kim HK. Emergency department utilization in patients with hypertrophic cardiomyopathy: a nationwide population-based study. Sci Rep 2022; 12:3534. [PMID: 35241727 PMCID: PMC8894351 DOI: 10.1038/s41598-022-07463-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Despite the increasing burden of hypertrophic cardiomyopathy (HCM) on healthcare resources, data on emergency department (ED) utilization in HCM are lacking. This nationwide population-based study extracted 14,542 HCM patients from the National Health Insurance Service database between 2015–2016, and investigated their ED utilization during a one-year period. The reason for ED utilization was defined as the primary diagnosis upon discharge from EDs. The clinical outcome was defined as hospitalization or all-cause mortality within 90 days after the ED visits. A total of 3209 (22.1%) HCM patients visited EDs within a one-year period (mean age, 66.8 ± 13.8 years; male, 57.4%). The majority (71.1%) of HCM patients who visited the EDs were aged ≥ 60 years. The ED utilization rate was higher in women than in men (26.3% versus 19.7%, P < 0.001). Cardiovascular diseases were the most common reason for ED visits (n = 1333, 41.5%). Among HCM patients who visited EDs, 1195 (37.2%) were hospitalized, and 231 (7.2%) died within 90 days. ED visits for cardiovascular disease was associated with a higher 90-day all-cause mortality (adjusted odds ratio, 2.72; 95% confidence interval 1.79–4.12). These findings would serve as a basis for future research to establish medical policies on ED utilization in HCM.
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Affiliation(s)
- You-Jung Choi
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Bongseong Kim
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Jung Lee
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Heesun Lee
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung-Pyo Lee
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung-Kwan Kim
- Cardiac Diagnostic Test Unit, Section of Cardiovascular Imaging, Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Park JB, Shin E, Lee JE, Lee SJ, Lee H, Choi SY, Choe EK, Choi SH, Park HE. Corrigendum: Genetic Determinants of Visit-to-Visit Lipid Variability: Genome-Wide Association Study in Statin-Naïve Korean Population. Front Cardiovasc Med 2022; 9:869777. [PMID: 35299978 PMCID: PMC8922016 DOI: 10.3389/fcvm.2022.869777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Eun Kyung Choe
- Department of Surgery, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Seung Ho Choi
- Division of Pulmonology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
- *Correspondence: Hyo Eun Park ;
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Park JB, Shin E, Lee JE, Lee SJ, Lee H, Choi SY, Choe EK, Choi SH, Park HE. Genetic Determinants of Visit-to-Visit Lipid Variability: Genome-Wide Association Study in Statin-Naïve Korean Population. Front Cardiovasc Med 2022; 9:811657. [PMID: 35174233 PMCID: PMC8842998 DOI: 10.3389/fcvm.2022.811657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Aim There is a growing evidence that fluctuation in lipid profiles is important in cardiovascular outcomes. We aimed to identify single nucleotide polymorphism (SNP) variants associated with low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) variability in statin-naïve Korean subjects and evaluate their associations with coronary atherosclerosis. Methods In statin-naïve subjects from Gene-Environment of Interaction and phenotype cohort, we performed genome-wide association studies of lipid variability; the discovery (first) and replication (second) sets included 4,287 and 1,086 subjects, respectively. Coronary artery calcium (CAC) score and degree of coronary artery stenosis were used as outcome measures. Cholesterol variability was determined by standard deviation and average successive variability, and significant coronary atherosclerosis was defined as CAC score ≥400 or coronary stenosis ≥70%. Results Mean HDL-C and LDL-C level were 54 ± 12 and 123 ± 30 mg/dL in the first set and 53 ± 12 and 126 ± 29 mg/dL in the second set. APOA5 rs662799 and APOA5 rs2266788 were associated with LDL-C variability and PXDNL rs80056520, ALDH2 rs671, HECTD4 rs2074356, and CETP rs2303790 were SNPs associated for HDL-C variability. APOA5 rs662799 passed Bonferroni correction with p-value of 1.789 × 10−9. Among the SNPs associated with cholesterol variability, rs80056520 and rs2266788 variants were associated with CACS ≥400 and coronary stenosis ≥70% and rs662799 variant was associated with coronary stenosis ≥70%. Conclusion Two SNPs associated with LDL-C variability (APOA5 rs662799 and rs2266788) and one SNP associated with HDL-C variability (PXDNL rs80056520) were significantly associated with advanced coronary artery stenosis. Combining GWAS results with imaging parameters, our study may provide a deeper understanding of underlying pathogenic basis of the link between lipid variability and coronary atherosclerosis.
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Affiliation(s)
- Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Eun Kyung Choe
- Department of Surgery, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Seung Ho Choi
- Division of Pulmonology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
- *Correspondence: Hyo Eun Park ;
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Park CS, Park JJ, Hwang IC, Park JB, Park JH, Cho GY. Myocardial strain to identify benefit from beta-blockers in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:1248-1257. [PMID: 35001562 PMCID: PMC8934950 DOI: 10.1002/ehf2.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Not all patients with heart failure with reduced ejection fraction (HFrEF) benefit equally from beta‐blockers. Previous studies suggest that myocardial strain that reflects myocardial deformation may have a better prognostic value than the left ventricular ejection fraction. We aimed to evaluate the differential effect of beta‐blockers according to the global longitudinal strain (GLS) in patients with HFrEF. Methods and results Of the 4312 patients in the Strain for Risk Assessment and Therapeutic Strategies in Patients with Acute Heart Failure registry, we included 2126 HFrEF patients whose data on beta‐blocker use and GLS were available. Patients were categorized into two groups: one group of patients had GLS ≥ 10%, and the other group had GLS < 10%. The primary outcome was 5 year all‐cause mortality according to beta‐blocker use. Of the 2126 patients with HFrEF, 526 (24.7%) and 1600 (75.3%) patients had GLS ≥ 10% and <10%, respectively. Overall, 1399 patients (65.8%) received beta‐blockers, and 864 (40.6%) patients died during the 5 year follow‐up. Beta‐blocker use was associated with improved survival in patients with GLS < 10% in both the inverse probability treatment‐weighted (hazard ratio 0.70, 95% confidence interval 0.59–0.83, P < 0.001) and Cox regression analyses (hazard ratio 0.69, 95% confidence interval 0.59–0.81; P < 0.001). However, beta‐blocker use was not associated with better survival in patients with GLS ≥ 10% in the inverse probability treatment‐weighted and Cox regression analyses (both P > 0.05). Conclusions Beta‐blocker use appears to be associated with improved survival in patients with HFrEF and GLS < 10%, but this is not the case in patients with GLS ≥ 10%. Therefore, GLS may be used to identify patients who have attenuated benefits from beta‐blockers in HFrEF. Clinical Trial Registration: ClinicalTrials.gov: NCT03513653 (https://clinicaltrials.gov/ct2/show/NCT03513653).
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Affiliation(s)
- Chan Soon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Joo Park
- Division of Cardiology, Cardiovascular Center & Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - In-Chang Hwang
- Division of Cardiology, Cardiovascular Center & Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Hyeong Park
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Cardiovascular Center & Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
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Park J, Hwang IC, Yoon YE, Park JB, Park JH, Cho GY. Feasibility of the contraction-relaxation coupling index in outcome prediction for patients with acute heart failure. ESC Heart Fail 2022; 9:1228-1238. [PMID: 34981649 PMCID: PMC8934974 DOI: 10.1002/ehf2.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/20/2021] [Accepted: 12/17/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Contemporary heart failure (HF) classification based on left ventricular (LV) ejection fraction is limited for comprehensive assessment of LV function. We aimed to validate the feasibility of the contraction-relaxation coupling index (CRC) as a novel predictor for clinical outcomes in patients with acute HF. METHODS AND RESULTS A total of 3266 consecutive patients (median age: 74 years, 53% male) with acute HF were included. CRC was defined as the ratio of end-diastolic elastance (LV end-diastolic pressure/stroke volume) to end-systolic elastance (LV end-systolic pressure/end-systolic volume). The risk for 1 year composite endpoint of all-cause mortality or hospitalization for HF (primary outcome) was compared after group categorization using CRC tertiles (Tertile 1: CRC ≤ 0.17, Tertile 2: 0.17 < CRC ≤ 0.40, and Tertile 3: 0.40 < CRC). The median CRC was 0.3 and the median LVEF was 42%. After adjustment for clinical and echocardiographic covariates, CRC was an independent predictor for the primary outcome (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.47-2.07 in Tertile 3 and HR: 1.21, 95% CI: 1.02-1.44 in Tertile 2 when compared with Tertile 1; HR: 1.23, 95% CI: 1.14-1.33 per one-standard deviation increment in CRC). The risk model with CRC showed better performance in outcome discrimination than the model with LVEF (c-statistic 0.701 vs. 0.699, P for difference <0.001). Patients with higher CRC demonstrated better effectiveness of neurohormonal blockade for the primary outcome compared with those with lower CRC (HR: 0.38, 95% CI: 0.29-0.50 in Tertile 3 and HR: 0.67, 95% CI: 0.52-0.89 in Tertile 1). CONCLUSIONS CRC provides an independent value for outcome prediction in patients with acute HF. CRC would be a sensitive indicator for prognostic risk stratification and for predicting treatment response to the neurohormonal blockade.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro 173beon-gil, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro 173beon-gil, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro 173beon-gil, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.,Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro 173beon-gil, Seongnam, Gyeonggi-do, 13620, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
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45
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Sohn IS, Kim CJ, Yoo BS, Kim BJ, Choi JW, Kim DI, Lee SH, Song WH, Jeon DW, Cha TJ, Kim DK, Lim SH, Nam CW, Shin JH, Kim U, Kwak JJ, Park JB, Cha JH, Kim YJ, Choi J, Lee J. Clinical impact of guideline-based practice and patients' adherence in uncontrolled hypertension. Clin Hypertens 2021; 27:26. [PMID: 34911572 PMCID: PMC8672596 DOI: 10.1186/s40885-021-00183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic diseases like hypertension need comprehensive lifetime management. This study assessed clinical and patient-reported outcomes and compared them by treatment patterns and adherence at 6 months among uncontrolled hypertensive patients in Korea. Methods This prospective, observational study was conducted at 16 major hospitals where uncontrolled hypertensive patients receiving anti-hypertension medications (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) were enrolled during 2015 to 2016 and studied for the following 6 months. A review of medical records was performed to collect data on treatment patterns to determine the presence of guideline-based practice (GBP). GBP was defined as: (1) maximize first medication before adding second or (2) add second medication before reaching maximum dose of first medication. Patient self-administered questionnaires were utilized to examine medication adherence, treatment satisfaction and quality of life (QoL). Results A total of 600 patients were included in the study. Overall, 23% of patients were treated based on GBP at 3 months, and the GBP rate increased to 61.4% at 6 months. At baseline and 6 months, 36.7 and 49.2% of patients, respectively, were medication adherent. The proportion of blood pressure-controlled patients reached 65.5% at 6 months. A higher blood pressure control rate was present in patients who were on GBP and also showed adherence than those on GBP, but not adherent, or non-GBP patients (76.8% vs. 70.9% vs. 54.2%, P < 0.001). The same outcomes were found for treatment satisfaction and QoL (P < 0.05). Conclusions This study demonstrated the importance of physicians’ compliance with GBP and patients’ adherence to hypertensive medications. GBP compliance and medication adherence should be taken into account when setting therapeutic strategies for better outcomes in uncontrolled hypertensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00183-1.
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Affiliation(s)
- Il Suk Sohn
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Chong Jin Kim
- Department of Cardiology, CHA University Gangnam Medical Center, Seoul, Republic of Korea.
| | - Byung-Su Yoo
- Wonju Severance Christian Hospital, Yonsei University Health System, Wonju, Republic of Korea
| | - Byung Jin Kim
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Doo-Il Kim
- Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang-Hak Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyuk Song
- Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dong Woon Jeon
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tae Jun Cha
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Dae-Kyeong Kim
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jae-Jin Kwak
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jun-Bean Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Hye Cha
- Viatris Korea Ltd., Seoul, Republic of Korea
| | | | - Jimi Choi
- Korea University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Korea University College of Medicine, Seoul, Republic of Korea
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Kwak S, Park JB. Impact of atrial fibrillation on the progression and outcomes of isolated mild functional tricuspid regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is increasingly recognized as a cause of tricuspid regurgitation (TR) in the structurally normal tricuspid valve. However, there are limited data regarding the impact of AF on TR progression and its long-term cardiovascular outcomes.
Purpose
We aimed to investigate the association of AF with the significant TR progression and its impact on clinical outcomes among patients with isolated mild functional TR.
Methods
We studied 834 patients with mild function TR identified on the echocardiography between 2007 and 2019, whose follow-up echocardiography beyond 1-year was available. Major exclusion criteria were the overt causes of primary and secondary TR (i.e., concomitant left-sided heart disease). Primary endpoint was the significant TR progression to more than a moderate degree on the follow-up echocardiography. Composite cardiac event was defined as cardiovascular death, TR surgery, and heart failure admission due to TR.
Results
Of 834 patients with isolated mild functional TR (mean age 65.6 years, 41% men), 292 (35.0%) patients had AF at the baseline. Patients with AF were older and had larger left atrium compared to those without. During the median of 4.55 years follow-up (interquartile interval 2.56–7.24 years), 36 patients developed a significant TR ≥ moderate degree. The cumulative rate of TR progression was significantly higher in patients with AF than those without (11.3% versus 0.6%, P<0.001) (Figure 1). Multivariable Cox analyses showed that AF was associated with a 3-fold higher risk of TR progression (adjusted hazard ratio 3.50, 95% confidence interval 1.42–8.65). Regarding the cardiovascular outcomes, patients who developed significant TR had a higher rate of composite cardiac events compared to those who did not (cardiac events: 38.9% versus 6.3% P<0.001) (Figure 2).
Conclusions
AF is a strong risk factor for TR progression among patients with isolated mild functional TR. In addition, the development of significant TR is associated with worse cardiovascular outcomes. These findings highlight the important pathophysiology of AF on TR development and its clinical consequences.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Kwak
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - J B Park
- Seoul National University Hospital, Seoul, Korea (Republic of)
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47
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Park CS, Hwang IC, Park JJ, Park JH, Park JB, Cho GY. Determinants of the survival benefit associated with statins in patients with acute heart failure. ESC Heart Fail 2021; 8:5424-5435. [PMID: 34612019 PMCID: PMC8712823 DOI: 10.1002/ehf2.13637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/12/2021] [Accepted: 09/19/2021] [Indexed: 12/29/2022] Open
Abstract
Aims The benefit of statins in patients with heart failure (HF) remains controversial and the mechanism of action is largely speculative. We investigated the determinants of the survival benefit associated with statins in HF patients. Methods and results We enrolled 1680 acute HF patients receiving statins and 2157 patients not receiving statins admitted between 2009 and 2016. The left ventricular (LV) global longitudinal strain (GLS) was assessed as a measure of myocardial contractility. The primary outcome was 5 year all‐cause mortality. Statin therapy was independently associated with improved survival in patients with HF with preserved ejection fraction (HFpEF) [adjusted hazard ratio (HR) 0.781, 95% confidence interval (CI) 0.621–0.981, P = 0.034], but not in those with HF with reduced EF (HFrEF) (adjusted HR 0.881, 95% CI 0.712–1.090, P = 0.244). Mortality reduction associated with statin therapy was significant in patients with ischaemic HF (adjusted HR 0.775, 95% CI 0.607–0.989, P = 0.040), but not in those with non‐ischaemic HF (adjusted HR 0.895, 95% CI 0.734–1.092, P = 0.275). The relative magnitude of survival benefit with statin therapy increased as LV‐EF and LV‐GLS increased, with a steeper dose–response relationship in patients with ischaemic HF. In the subgroup of patients with ischaemic HF, survival benefit with statin therapy was confined to those ≤75 years of age. Conclusions Our study suggests that the survival benefit of statins is confined to patients with HFpEF and those with ischaemic HF. Myocardial contractility may modulate the prognostic effects of statins in HF patients, particularly when the aetiology is ischaemic rather than non‐ischaemic.
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Affiliation(s)
- Chan Soon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Lee HJ, Kim HK, Lee SC, Kim J, Park JB, Hwang IC, Choi YJ, Lee SP, Chang SA, Lee W, Park EA, Cho GY, Kim YJ. Supplementary role of left ventricular global longitudinal strain for predicting sudden cardiac death in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:1108-1116. [PMID: 34542591 DOI: 10.1093/ehjci/jeab187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS We investigated the prognostic role of left ventricular global longitudinal strain (LV-GLS) and its incremental value to established risk models for predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS LV-GLS was measured with vendor-independent software at a core laboratory in a cohort of 835 patients with HCM (aged 56.3 ± 12.2 years) followed-up for a median of 6.4 years. The primary endpoint was SCD events, including appropriate defibrillator therapy, within 5 years after the initial evaluation. The secondary endpoint was a composite of SCD events, heart failure admission, heart transplantation, and all-cause mortality. Twenty (2.4%) and 85 (10.2%) patients experienced the primary and secondary endpoints, respectively. Lower absolute LV-GLS quartiles, especially those worse than the median (-15.0%), were associated with progressively higher SCD event rates (P = 0.004). LV-GLS was associated with an increased risk for the primary endpoint, independent of the LV ejection fraction, apical aneurysm, and 2014 European Society of Cardiology (ESC) risk score [adjusted hazard ratio (aHR) 1.14, 95% confidence interval (CI) 1.02-1.28] or 2011 American College of Cardiology/American Heart Association (ACC/AHA) risk factors (aHR 1.18, 95% CI 1.05-1.32). LV-GLS was also associated with a higher risk for the composite secondary endpoint (aHR 1.06, 95% CI 1.01-1.12). The addition of LV-GLS enhanced the performance of the ESC risk score (C-statistic 0.756 vs. 0.842, P = 0.007) and the 2011 ACC/AHA risk factor strategy (C-statistic 0.743 vs. 0.814, P = 0.007) for predicting SCD. CONCLUSION LV-GLS is an important prognosticator in patients with HCM and provides additional information to established risk stratification strategies for predicting SCD.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
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Kim JW, Ryu H, Park JB, Moon SH, Myung SJ, Park WB, Yim JJ, Yoon HB. Erratum: Correction of Text and Table in the Article "Establishing a Patient-centered Longitudinal Integrated Clerkship: Early Results from a Single Institution". J Korean Med Sci 2021; 36:e249. [PMID: 34463067 PMCID: PMC8405406 DOI: 10.3346/jkms.2021.36.e249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022] Open
Abstract
This corrects the article on p. e419 in vol. 35, PMID: 33372421.
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Affiliation(s)
- Ju Whi Kim
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunjin Ryu
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hui Moon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Jung Myung
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
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50
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Kim WB, Park JB, Kim YJ. Usefulness of Relative Handgrip Strength as a Simple Indicator of Cardiovascular Risk in Middle-Aged Koreans. Am J Med Sci 2021; 362:486-495. [PMID: 34419424 DOI: 10.1016/j.amjms.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 04/06/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Reduced muscular strength, measured by handgrip strength, has been associated with increased risk for cardiovascular disease (CVD) and mortality. However, the prognostic significance of handgrip strength has been less well-studied in the middle-aged Korean population. This study determined whether handgrip strength predicted 10-year CVD risk in this population and whether there is a sex-specific difference. METHODS The data were derived from the 2015 Korean National Health and Nutrition Examination Survey that included total of 2776 participants aged 40-69 years without prior history of CVD (men: 1184; women: 1592). Isometric relative handgrip strength was calculated by dividing absolute handgrip strength by body mass index. Participants were classified into three groups by their 10-year Framingham cardiovascular risk score: low (<10%), intermediate (10-19%), and high (≥20%). RESULTS In men, relative handgrip strength was higher in the absence of hypertension, dyslipidemia, and diabetes compared with in the presence of these CVD risk factors. In women, a higher relative handgrip strength was observed in the absence of hypertension and dyslipidemia but not in the absence of diabetes compared with their counterparts. Advanced age was inversely associated with relative handgrip strength for both sexes. Multivariate logistic regression analysis demonstrated that an increased relative handgrip strength was a significant and independent predictor of low 10-year CVD risk among middle-aged women (odds ratio range 0.09-0.49, p < 0.001), but not among men. CONCLUSIONS Handgrip strength is a simple and effective screening tool for risk stratification for CVD in middle-aged Korean women.
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Affiliation(s)
- Won Bin Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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